Also known as migralepsy, this condition occurs when a seizure is triggered by a migraine aura. It is a rare but serious complication that combines features of both epilepsy and migraine. Proper diagnosis and management often involve collaboration between neurologists specializing in epilepsy and headache disorders.
Migraine aura-triggered seizures, also known as migralepsy, are a rare complication in which a seizure is directly precipitated by a migraine aura. This condition lies at the intersection of migraine and epilepsy, reflecting the shared mechanisms between these two neurological disorders.
The prevalence of migraine in people with epilepsy ranges from 8-24% and the prevalence of epilepsy in people with migraine is 1–17%. Epilepsy doesn’t cause migraine but it can cause headaches.
The exact cause of a migraine aura-triggered seizure is not fully understood, but several factors contribute to the overlapping pathophysiology of migraine and epilepsy, including cortical spreading depression (CSD) is thought to play a key role. CSD is a wave of hyperactivity followed by inhibition that spreads across the brain’s cortex, which may provoke both the aura and subsequent seizure in vulnerable individuals.
Both disorders are associated with hyperexcitable brains, potentially influenced by:
- Defects in ion channels
- Impairment of the sodium-potassium pump
- Genetic predispositions
Both migraine and epilepsy can present with an aura as a warning sign of an impending event. While the symptoms of migraine aura and epileptic aura may overlap—such as visual disturbances, numbness, or phantom smells—key differences in their presentation and timing often help differentiate the two conditions. For example a migraine aura usually has a slower onset and can last up to one hour whilst epileptic auras have a rapid onset and typically last 5 minutes.
In a migraine aura-triggered seizure, the seizure typically occurs during or within one hour of the aura phase of a migraine attack, and symptoms of migraine aura-triggered seizures combine features of both conditions. Individuals may experience:
- Visual disturbances such as zigzag patterns, flashes of light, or temporary vision loss
- Sensory changes, including tingling or numbness in the face or limbs
- Difficulty speaking or understanding speech
- Seizure activity, such as loss of consciousness, convulsions, or abnormal movements
Diagnosing this condition requires careful evaluation to differentiate it from other disorders. Tests such as EEG (to detect abnormal brain activity) and imaging studies like MRI or CT scans (to rule out structural causes) are often employed.
Treatment involves addressing both the migraine and seizure components. Preventive migraine therapies, including anti-CGRP medications, beta-blockers, or calcium channel blockers, may help reduce the frequency of attacks. Anti-seizure medications like topiramate or lamotrigine are often effective in controlling seizures and may have dual benefits for migraine prevention.
While migraine aura-triggered seizures are rare, they can have a significant impact on quality of life. With accurate diagnosis and appropriate treatment, individuals can effectively manage this condition and reduce the risk of recurrence. If you experience a seizure following a migraine aura, seek immediate medical attention to ensure prompt and appropriate care.