Headache and Epilepsy

Headaches, especially migraines, and epilepsy have common clinical features. Both are neurological disorders that have a genetic predisposition and share a common pathophysiological mechanisms including an imbalance between excitatory and inhibitory factors that result in spells of altered brain function and autonomic symptoms.

Headache can be a sole manifestation of epileptic seizure and headache is commonly associated with preictal, ictal and postictal symptoms as in epilepsy patients. Headache in epilepsy patients can occur as an interictal, peri-ictal, ictal or postictal symptoms with diverse clinical features, making it difficult to differentiate migraine from epilepsy in some patients.

Migraine and epilepsy are highly comorbid conditions and several anti-epileptic drugs (AED) are also used to treat migraine patients. Valproic acid (VPA) and topiramate (TPM) are approved AED for the preventive use of migraine. Many other drugs including gabapentin, acetazolamide, carbamazepine, oxcarbazepine, and zonisamide are also suggested to have the preventive role for migraine.

The incidence of headaches associated with epileptic seizures is quite different among various studies, however, all studies consistently show that postictal headache is the most common type of headache, with the incidence from 24 to 60%. In one study, headache was the most frequently encountered postictal symptom in patients with epilepsy (38%) followed by dizziness and confusion, and the presence of postictal headache was very useful in differentiating patients with epileptic seizures from patients with non-epileptic seizures

Kim, D. W., & Lee, S. K. (2017). Headache and Epilepsy. Journal of Epilepsy Research, 7(1), 7–15. http://doi.org/10.14581/jer.17002

By: Tanesha Reynolds, DNP, FNP