Migraine and epilepsy: clinical and pathophysiological relations

Abstract

Migraine and epilepsy are both chronic disorders characterised by recurrent neurological attacks, with a partial clinical and therapeutic overlap and frequently occurring together. Although still incompletely clarified, the possible existence of a link between migraine and epilepsy has long been debated. In this paper the epidemiologic evidence of migraine and epilepsy comorbidity, the possible occurrence of both disturbances in close temporal association, possible shared physiopathologic mechanisms and the rationale for antiepileptic drug use in migraine prophylaxis will be discussed.

Neurological comorbidity and epilepsy: implications for treatment

“…Finally, four double-blind studies, the last of which compared TPM with propanolol, have demonstrated the efficacy of TPM in migraine prevention (8,95). Efficacy of LTG in migraine prophylaxis was evaluated in a double-blind trial, which failed to show a significant therapeutic effect of this drug (95). A possible interpretation of this negative result might be that LTG is only effective in the subpopulation of patients with migraine with aura.…”

“…This hypothesis is also based on two open studies, which found that LTG is effective in preventing migraine aura. It may be possible that also other new AEDs are effective in the prophylaxis of this condition (8,96) such as LEV and ZNS (95).…”

“…The rationale for their use is the hypothesis that migraine and epilepsy share several pathogenic mechanisms (8,94). In particular, it has been postulated that the pathophysiology of migraine result from altered cortical hyperexcitability which is a consequence of an imbalance between GABAergic inhibition and glutamatergic excitation (95). As AEDs modulate neuronal function through several effects and determine a reduction in neuronal excitability, these drugs should be effective in both these disorders (8,96).…”

“…Treatment with GBP has also been reported to reduce the severity and frequency of headaches by some double-blind studies (8). Finally, four double-blind studies, the last of which compared TPM with propanolol, have demonstrated the efficacy of TPM in migraine prevention (8,95). Efficacy of LTG in migraine prophylaxis was evaluated in a double-blind trial, which failed to show a significant therapeutic effect of this drug (95).…”

Migraine et épilepsie: symptômes cliniques communs, comorbidité et mécanismes physiopathologiques

“…Enfin, les crises d'épilepsie et les crises migraineuses peuvent survenir chez les patients au cours de pathologies communes comme les mitochondriopathies et/ou en raison d'une possible comorbidité existant entre les deux pathologies. Sur le plan physiopathologique, la mise en évidence de troubles de l'excitabilité corticale dans la maladie migraineuse et la découverte de mutations génétiques communes aux deux pathologies illustrent également les interactions pouvant exister entre les deux pathologies [8].…”