E-360 Edition 14: Seizures and headaches

Home > E-360 Edition 14: Seizures and headaches

It is no surprise that people who have seizures are more likely to get headaches, and there is a well-recognised relationship between headaches/migraine and epilepsy.

Headaches can occur at any time in connection with a seizure – before, during or after a seizure. They are particularly common after tonic-clonic seizures.

Having epilepsy means you are twice as likely to have migraine headaches. Migraine and epilepsy are frequently seen together. Both disorders have similar mechanisms such as an imbalance between excitatory and inhibitory factors in the brain that result in episodes of altered brain function and associated symptoms. Also, both have similar progression such as before, during and after symptoms. So it is not surprising that several antiepileptic drugs (AEDs) are effective and widely used for the prevention of migraine.

Headaches after a seizure (post ictal headache)

The most common headache associated with epilepsy is by far the postictal headache. It is estimated that 45% of people with epilepsy experience postictal headache. It most frequently occurs after tonic-clonic seizures but can also follow focal seizures. The pain of a postictal headache is usually widespread. It can be steady or throbbing and its intensity can range from mild to severe. These headaches can last between about 6 and 24 hours – sometimes even longer.

Headache during a seizure (ictal headache)

This is a rare type of headache and the headache itself is actually the symptom of a seizure. The headache varies – some pound like a migraine but others are sharp and steady. In some people the pain builds gradually but in others it begins suddenly. Ictal headaches can be seen in all types of epilepsy. There is a type of epilepsy syndrome in children (called benign epilepsy of childhood with occipital paroxysms) in which 25% of the children have headache as their only symptom which often leads to a mistaken diagnosis of migraine.

One interesting finding with people who have ictal headaches is that many of them have the feature of photosensitivity (when a flashing strobe light can trigger an abnormal EEG response) and a family history of epilepsy and migraine

Headaches just before a seizure (pre-ictal headache)

On occasion, a headache may be a sign that a seizure is approaching. These headaches are called pre-ictal because they occur before the seizure activity starts. They are generally brief but can be throbbing, steady, or sharp. Pre-ictal headaches are said to affect about 20% of people who have seizures that are difficult to control, but they may be under-reported because the seizure may interfere with memory of the headache.

Migraine

Migraine is the most represented type of headache in people with epilepsy.

Almost 12 percent of the general population experience migraine compared to just over 22 percent of people with epilepsy.

The symptoms of migraine can vary considerably, but many people experience throbbing head pain, sometimes localised to one side, which can be associated with sensitivity to light, sounds or smells, nausea or vomiting and blurred vision. But a migraine may also include other stages aside from the actual attack, including symptoms of an oncoming migraine (such as irritability, food cravings and depression) and an aura, which produces nervous system symptoms (most commonly visual changes such as flashing lights or blind spots).

People who have migraine headaches may have only one a year or may have one every day for several weeks at a time.

Migraines share some common features with epilepsy. Like seizures, they can be triggered by stress, fatigue, menstruation, and alcohol. The aura before a migraine is similar to an aura before a seizure. Even the brain activity on EEG is slightly abnormal during a migraine attack. There is some debate among doctors about whether a migraine headache can lead straight into a seizure and be considered a pre-ictal headache.

For more go to Migraine Vs Headache 

Other causes of headache

Seizures are not always the source of headaches for people with epilepsy. Lets not forget other factors come into play such as:

  • Tension headache
  • Antiepileptic drugs side effects
  • Diet and lifestyle factors
  • Headaches from (headache) medication overuse
  • Probable headache attributed to traumatic injury to the head
  • Other health conditions and medications.

Other types of headaches, not related to seizures or epilepsy, generally must be treated separately from your seizure disorder.

For more go to Common Types of Headache and What Causes Them

Treatment for seizure related headache

It seems rational to use AEDs for the prevention of migraine because both migraine and epilepsy share the same relationship of imbalance between excitatory and inhibitory factors. Sodium valproate and topiramate are approved AEDs for preventive use of migraine, and many other drugs including gabapentin, acetazolamide, carbamazepine, oxcarbazepine, and zonisamide were suggested to have a preventive role for migraine.

If your headaches aren’t connected to your seizures, don’t be afraid to seek treatment for both conditions. Treating your headaches should not interfere with the control of your seizures.

References:

Aatif M. Husain, MD Practical Epilepsy. Ch 41. Headaches and Epilepsy. T.A.Collins. Springer Publishing Company, 11 Sep. 2015

ICHD – Headache associated epileptic seizure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540694/table/t1-er-7-1-7/

Kim, D. W., & Lee, S. K. (2017). Headache and Epilepsy. Journal of Epilepsy Research7(1), 7–15. http://doi.org/10.14581/jer.17002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540694/

Mainieri, G., Cevoli, S., Giannini, G., Zummo, L., Leta, C., Broli, M., … Bisulli, F. (2015). Headache in epilepsy: prevalence and clinical features. The Journal of Headache and Pain, 16, 72. http://doi.org/10.1186/s10194-015-0556-y https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540713/

  1. Mameniškiene, I. Karmonaite, R. Zagorskisb. The burden of headache in people with epilepsy. Seizure 41 (2016) 120–126.