Migraine aura-triggered seizure

1.4.4 Migraine aura-triggered seizure

Description:
A seizure triggered by an attack of migraine with aura.

Diagnostic criteria:
A. A seizure fulfilling diagnostic criteria for one type of epileptic attack, and criterion B below
B. Occurring in a patient with 1.2 Migraine with aura, and during, or within 1 hr after, an attack of migraine with aura
C. Not better accounted for by another diagnosis.

Comment:
Migraine and epilepsy are prototypical examples of paroxysmal brain disorders. While migraine-like headaches are quite frequently seen in the epileptic postictal period, sometimes a seizure occurs during or following a migraine attack. This phenomenon, sometimes referred to as migralepsy, is a rare event, originally described in patients with 1.2 Migraine with aura. Evidence for association with 1.1 Migraine without aura is still lacking.

Migraine aura-triggered seizure

ICDH 3 Beta defines this as an epileptic seizure occurring during or within an hour after an attack of migraine with aura.  Migraine and epilepsy are comorbid, episodic paroxysmal disorders.  A seizure occurring during or after an attack of migraine with aura may be called “migralepsy.”

Literature Review of migraine-triggered seizure

Marks and Ehrenberg[i] reported in 1993 in Neurology on” Migraine-related seizures in adults with epilepsy, with EEG correlation.”  Out of 395 adult seizure patients 79 (20%) also had migraine and 13 of these patients (3%) experienced a seizure during or just after an attack of migraine aura.  They noted that patients with seizures during menstruation (catamenial epilepsy) and patients with migraine with aura were at increased risk for having a seizure during a migraine with aura attack.  In 2 patients the researchers recorded the entire sequence from migraine aura to partial seizure and they noted EEG changes during the migraine aura that came before the electrographic complex partial seizure that followed.  They also found PLEDS (periodic lateralized epileptic discharges) in 5 other patients which developed in close relationship to the migraine attack.  Marks and Ehrenberg also noted improved seizure control with combination antimigraine and antiepileptic drugs in 6 patients who did not respond to anticonvulsant medication alone.

In 2000 Friedenberg and Dodick[ii] writing in Headache on “Migraine-Associated Seizure: A Case of Reversible MRI Abnormalities and Persistent Nondominant Hemisphere Syndrome” reported a case from the Mayo Clinic who had a prolonged attack of migraine without aura.  Mateo, et al,[iii] writing in Headache in 2004 on “Migraine-Associated Seizures With Recurrent and Reversible Magnetic Resonance Imaging Abnormalities" reported a patient with repeated attacks of migraine with aura and seizures who had brain transient MRI abnormalities.  The location of the MRI abnormalities always correlated with the neurologic deficits.  Velioglu, et al,[iv] writing in 2005 in Cephalagia on “The impact of migraine on epilepsy: a prospective prognosis study” studied the impact of migraine on epilepsy and found that an epilepsy migraine group had a significantly lower probability of being seizure free over 10 years compared with a group of patients with epilepsy alone.  They concluded that: “Comorbid migraine had a negative effect on the prognosis of epilepsy.”  Lastly, Merlino, et al,[v] writing in 2007 in Headache on “Seizures With Prolonged EEG Abnormalities During an Attack of Migraine Without Aura” reported a case of a patient who presented with 2 generalized seizures during an attack of migraine without aura who had “transient, diffuse, irregular high voltage slow activity without clear epileptiform abnormalities in subsequent EEG recordings."

Tsuji, S. writing on Migraine and epilepsy in Rinsho Shinkeigaku stated:

 Migraine and epilepsy are both common episodic disorders that share many clinical features and underlying pathophysiological mechanisms. The comorbidity of these two conditions is well known. However, the temporal association between migraine and epilepsy is a controversial issue, since these two conditions may occur in numerous ways. Four types of association between headache and epileptic seizure are recognized: pre-ictal headache, headache as the expression of an epileptic manifestation, post-ictal headache, and inter-ictal headache. The classification of epilepsy by the International League Against Epilepsy did not refer to the epileptic headache. On the other hand, the International Classification of Headache Disorders, 3rd edition (ICHD-3) defines three entities: migraine aura-triggered seizure which sometimes referred to as migralepsy, hemicrania epileptica, and post-ictal headache. However, ICHD-3 mentions that there is a complex and bidirectional association between migraine and epilepsy. Most of the previous reports of migralepsy corresponded to occipital seizures that mimic migraine with aura. The term migralepsy has recently been criticized. Migraine and epilepsy share several pathophysiological mechanisms which involve neurotransmitters and iron channel dysfunctions. There is the hypothesis of a shared genetic susceptibility to migraine and epilepsy. Strong support of a shared genetic basis comes from familial hemiplegic migraine.

[i] Marks DA, Ehrenberg BL.  Migraine-related seizures in adults with epilepsy, with EEG correlation.  Neurology.  1993;43:2476.

[ii] Friedenberg S , Dodick DW.  Migraine-Associated Seizure: A Case of Reversible MRI Abnormalities and Persistent Nondominant Hemisphere Syndrome.  Headache: The Journal of Head and Face Pain.  40 (6), 487–490.

[iii] Mateo I, Foncea N, Vicente I, Beldarrain MG, Garcia-Monco JC.  Migraine-Associated Seizures With Recurrent and Reversible Magnetic Resonance Imaging Abnormalities. Headache: The Journal of Head and Face Pain.  2004;44(3), 265–270.

[iv] Velioğlu SK, Boz C, Özmenoğlu M. The impact of migraine on epilepsy: a prospective prognosis study. Cephalalgia.  2005;25(7):528–535.

[v] Merlino G, Valente M, D'Anna S, Gigli GL.  Seizures With Prolonged EEG Abnormalities During an Attack of Migraine Without Aura.  Headache: The Journal of Head and Face Pain.  2007;47 (6):919–922.

Vi Tsuji, S. Migraine and epilepsy. Rinsho Shinkeigaku. (Article in Japanese) 2014;54(12):1003-5.