- Migralepsy refers to the occurrence of an epileptic seizure after a migraine with aura.
- The scientific community doesn’t fully agree whether migralepsy is a separate diagnosis.
- Migraine attacks and seizures may be connected by similar patterns of brain activity. Scientists have proposed that the electrical wave in a migraine attack can lower the threshold for a seizure to occur.
If you’ve had migraine with aura that triggered an epileptic seizure, you might have experienced migraine-induced epilepsy.
Another name for this phenomenon is migralepsy.
Scientists have debated the existence and terminology of this phenomenon for some time.
Currently, the International Classification of Headache Disorders (ICHD-3) acknowledges it as “migraine aura-triggered seizure.”
However, epilepsy authorities do not acknowledge the condition.
What it is
Migralepsy is a rare event in which you experience a migraine episode with an aura and then a seizure soon afterward. The migraine episode triggers the seizure.
However, a 2018 review noted that epilepsy and migraine can often be hard to tell apart. Both cause episodes or “attacks,” and both conditions can cause similar symptoms, such as:
- visual changes
What it isn’t
You might experience a migraine episode after a seizure during what’s called the postictal state, but experts don’t consider this migralepsy.
If you experience migraine episodes and you have epilepsy, but the two don’t seem to be related, that’s not migralepsy either.
Here are the symptoms you’ll experience in the order they appear in migralepsy, according to the ICHD-3.
1. Migraine with aura
First you’ll have a migraine episode with an aura.
The aura happens minutes or hours before the headache starts and each symptom can last about an hour. An aura can also happen during the headache.
An aura is a collection of neurological symptoms that usually come on gradually. You might experience all or just some of them.
- Visual symptoms or a “visual aura” are most common. For example, you might see a zigzag pattern or wavy lines near the point you’re focusing your eyes on. This could spread or move across your field of vision over time.
- Sensory symptoms are the second most common aura symptom. You might feel pins and needles or numbness.
Less common aura symptoms include motor weakness and speech disturbances, like slowed speech or feeling unable to speak.
There are several subtypes of migraine with aura. Your doctor will be able to help you identify which subtype you’re experiencing.
Migralepsy isn’t normally associated with migraine episodes that do not come with an aura. However, more research is needed.
With migralepsy, you experience a seizure within 1 hour of having migraine with aura.
A seizure is an episode in which you move involuntarily for a short period of time. It can affect all or part of your body and you may lose control of your bladder or bowels. Sometimes seizures cause you to lose consciousness.
Types of epileptic seizures include:
- Absence seizures. These can cause you to stare into space or blink rapidly.
- Tonic-clonic seizures. Also called a grand mal seizure, this is usually the most serious type of seizure. If you’re having one, you might call out, fall down, experience muscle spasms, or become unconscious.
- Simple focal seizures. You might twitch and perceive a new smell or taste.
- Complex focal seizures. This type of seizure might make you unable to respond to questions or directions for a few minutes.
- Secondary generalized seizures. This is when you have a focal seizure followed by a generalized seizure, such as absence or tonic-clonic.
Migraine and seizures may be connected by similar patterns of brain activity. However, scientists don’t currently understand exactly how they’re related.
About 1 to 17 percent of people who have migraine also have epilepsy, and people with epilepsy have reported a frequency of migraine episodes of 8.4 to 20 percent, according to a 2011 review of research.
In a seizure, massive waves of electrical activity pass through areas of the brain, activating many neurons in sync.
In a migraine episode, your brain experiences a similar slowly spreading wave of electrical activity. It can last for several minutes, and scientists have found it’s associated with experiencing migraine aura.
Scientists have proposed that the electrical wave in a migraine episode can lower the threshold for a seizure to occur, meaning you may be more likely to experience a seizure.
Factors that might increase your risk of migralepsy include having:
- genes that affect neurons’ metabolism
- issues with the metabolism of magnesium
- abnormalities with the channels in your brain that transfer electrical charges (ion channels)
Some drugs or surgery that help with migraine and epilepsy may help with migralepsy.
Migraine prevention drugs
Some migraine-preventing drugs may prevent cortical spreading depression — the slow wave of electrical activity in your brain — that happens when you experience migraine with aura.
These include sodium valproate or valproic avid (Depakene, Depakote, Epival) and topiramate (Topamax, Trokendi XR, Qudexy XR), which are approved by the Food and Drug Administration (FDA).
If you have migralepsy that isn’t going away with treatment, your doctor may consider trying opioids. Opioids are a prescription medication used to treat moderate to severe pain. They have a risk of serious side effects, including addiction.
A 2017 reviewTrusted Source of five case studies found that opioids might have a strong preventive effect against migralepsy.
The review followed five people who experienced a combination of migraine and drug-resistant epilepsy, in which migraine episodes appeared to trigger the seizures.
In all five people, migraine episodes and seizures completely stopped when people took the opioid drug oxycodone daily. When they stopped taking the drug, the migraine episodes and seizures resumed.
It’s important to note that these were case studies, so they’re not conclusive. More research is needed on the use of opioids as a treatment for migralepsy.
Some people with epilepsy who don’t respond to drug treatment to resolve their seizures may find surgical interventions effective.
If you think you have migralepsy, start by talking with a neurologist. You may need to get a referral from another healthcare professional first. Neurologists can diagnose your condition and help you find the treatment that’s most appropriate for your circumstances.
Changing your diet may also help reduce migralepsy episodes. Many studiesTrusted Source suggest that the ketogenic diet can help treat epilepsy.
The ketogenic diet is a high-fat, low-carbohydrate diet that makes the body shift from using blood sugar as fuel to using fats instead.
When this happens, a metabolic process breaks down fat into molecules called ketone bodies. Your body, including your brain cells, uses these for energy instead of glucose from carbohydrates.
Several studiesTrusted Source have shown that the ketogenic diet may help reduce or completely eliminate seizures in some children and adults with epilepsy.
A ketogenic diet may also help reduce migraine episodes, although there’s less research on this. A 2013 case studyTrusted Source found twin sisters’ migraine episodes stopped when they went on a low-calorie ketogenic diet.
A 2014 studyTrusted Source in women with overweight who also had migraine found more promising evidence. One group of participants went on a very-low-calorie ketogenic diet for 1 month, then a standard low-calorie diet for 5 more months.
The other group went on the standard low-calorie diet for the whole 6 months.
The group that started their regimen with 1 month of the ketogenic diet had significantly reduced:
- frequency of migraine episodes
- number of days per month with migraine episodes
Meanwhile, those who ate a standard low-calorie diet for the whole study period only started experiencing improvements at the 3-month mark.
The researchers suggested that the ketogenic diet might help improve metabolism in brain cells and potentially reduce inflammation.
However, more research is needed on the effects of diet on migralepsy.
How is migralepsy diagnosed?
According to the ICHD-3, a person needs to show the symptoms listed above to be diagnosed with migraine aura-triggered seizure.
However, experts still debate the diagnosis of migralepsy. If you think you have migralepsy, it’s best to see a neurologist and tell them what you experienced.
They’ll ask you about your particular symptoms and history and make a diagnosis and treatment plan based on your particular needs.
Can you drive with migralepsy?
If you’re driving and you sense you’re about to have a seizure, pull over immediately.
Some states ask people to tell the Department of Motor Vehicles (DMV) that they have epilepsy and require them to be seizure-free for a certain number of months before allowing them to drive.
Migraine symptoms may also make you unable to drive safely. These might include:
- significant pain
- visual aura
- impaired movement
- attentional difficulties
If you’re driving and you start to have a migraine, pull over and wait until the distracting or impairing symptoms pass.
If you’re taking medication for migralepsy, epilepsy, or migraine, the drug might also impair your ability to drive. Ask your healthcare team or pharmacist whether it’s safe to drive while you’re taking it.
Call for emergency medical help if a seizure lasts for more than 5 minutes or if you or someone you’re with has experienced an injury during a seizure.
If you had migraine with aura that triggered a seizure, you may have experienced migralepsy.
However, even if you aren’t sure, but you have experienced one or more severe headaches, it’s worth visiting a healthcare professional.
Write down all the information you can about what happened before, during, and after the episode, and tell your doctor. This will help them make a diagnosis and identify triggers.
If you had a seizure for the first time, whether or not you also had a migraine, see a healthcare professional.
Scientists argue about whether migralepsy, or migraine-induced epilepsy, actually exists as its own condition.
However, migraine and seizures are both serious conditions.
If you experience either independently, or if you experience them together and think you may have migralepsy, record information about the event and see a healthcare professional right away.
SOURCE: healthline.com by Stephanie Orford