Feature article: Headaches and Migraines and Epilepsy
Headaches and Epilepsy are neurological conditions; each can cause significant discomfort and negatively impact quality of life. At times, there is a connection between these two neurological conditions and the same person may experience both.
Let’s start today’s article by defining a headache and then discussing the different types of headaches that can occur in people who have epilepsy. Headaches are defined as pain or discomfort located not only in the head, but that can also occur in the face, or neck. Headaches and migraines are not the same. Headaches refer to general head pain, while migraines are a specific type of headache characterized by severe, often throbbing pain usually on one side of the head, often accompanied by additional symptoms like nausea, vomiting, sensitivity to light and sound, and sometimes visual disturbances (auras). Regular headaches don’t usually have these other symptoms.
Headaches when associated with epileptic seizures are defined in relation to the seizure (before, during or after). This is why you may hear your headaches described by doctors as pre-ictal, post-ictal, or inter-ictal.
Post-ictal headaches:
These occur after (post) a seizure (ictal) while the brain is still recovering from the seizure and can last for hours. Post ictal headaches are the most common type of headache in people with epilepsy (PWEs). Postictal headaches can resemble migraines because they typically present with throbbing or pounding sensations, often located on one side of the head, and can be accompanied by nausea and vomiting, sensitivity to light or noise, and confusion.
Pre-ictal headaches:
These occur before (pre) a seizure (ictal) and sometimes can be a warning sign that a seizure is about to happen. These can be brief and involve throbbing, steady, or sharp pain. About 20% of people who have seizures that are difficult to control experience preictal headaches (https://www.americanbrainfoundation.org/disease-connectionsmigraineandepilepsy/#:~:text=Epilepsy%20doesn't%20cause%20migraine,known%20as%20a%20postictal%20headache.).
Inter-ictal headaches:
These headaches occur between (inter) seizures (ictal) and may resemble migraines or tension headaches.
Epilepsy and migraines have been found to share certain triggers, including emotional stress, impoverished sleep, menstrual hormonal shifts, alcohol consumption, and compliance issues with medications (e.g., overdosing or skipping a dose). According to research, around 24-30% of patients with epilepsy also experience migraines, meaning a significant portion of people with epilepsy also suffer from migraines; studies indicate a higher prevalence of migraines in people with epilepsy compared to the general population. Some research shows that epilepsy and migraines may even share certain genetic or environmental risk factors and may even share certain underlying mechanisms (https://www.ncbi.nlm.nih.gov/books/NBK98193/), such as brain hyperexcitability.
Migraines can sometimes act as a trigger for seizures. In some PWEs, migraines may trigger seizures. It is thought that changes in brain activity during a migraine attack could potentially disrupt the electrical activity in the brain, leading to a seizure.
There are many possible causes of headaches in epilepsy including physiological and psychological ones. The most obvious trigger of headaches in persons with epilepsy (PWEs) is directly associated with brain activity that also brings about the seizures themselves:
Treatment of Headaches in Epilepsy:
Ictal headaches, will be resolved if antiseizure medication is being effective in controlling the seizures. The other types of headaches generally must be treated separately from your seizure disorder.
Medications:
If you are having headaches, bring this up to your epilepsy doctor. Some antiseizure medications used to treat epilepsy can sometimes also help relieve headaches. Topiramate (Topamax) is an example of a medication that can treat both epilepsy and migraines. Other medications often used to prevent headaches include beta-blockers such as Inderal (propranolol), calcium channel blockers such as verapamil, and Elavil (amitriptyline). Pain relievers, such as over-the-counter ibuprofen or acetaminophen, may also be effective. However, always ask your doctor before taking any medication (including over the counter ones) just to be sure.
Lifestyle modifications can also be helpful. For example, avoiding triggers for seizures, such as stress, lack of sleep, and caffeine, can help reduce the frequency of headaches. Furthermore, relaxation techniques, biofeedback, mindfulness, and massage therapy may also help manage headaches. Lastly, some people might have a sensitivity to certain foods which can trigger headaches, for example, aged cheese, alcohol, or processed foods. It is also important to stay well-hydrated by drinking plenty of water throughout the day; this can help prevent migraines.
Conclusion:
Headaches are considered a common co-occurrence with epilepsy and may be caused by the same underlying factors that cause seizures. Understanding the relationship between epilepsy and headaches is important for effective management of both conditions. If you are having headaches in addition to seizures, definitely bring this up to your doctor because there may be treatments that can reduce these painful symptoms and improve your quality of life.
