Ross Hauser, MD.

Here I will cover the possible connections between migraine and seizure disorder. These two disorders may have a common cause in ligamentous cervical instability (cervical ligament weakness and ligament damage in the cervical spine) that will cause the bones of the neck to wander out of place and compress and compromise the arteries, veins and nerves that pass through the upper cervical region. This compression can cause a block in the cerebral spinal fluid, the blood flow of the internal jugular veins, or distorted or compromised messages to and from the vagus nerves.

The connection with auras: Migraine headaches often come with an aura. Why? The aura is coming from electrical activity in the brain giving you the sense that you’re going to have a migraine. Seizures, dementia, and migraine could have the same etiology. They can be caused by a blockage of the jugular vein, that means the waste products can’t get out of the brain then the brain pressure goes up, the toxic metabolites from normal brain metabolism stay in the brain and thus you could get atrophy or damage of the brain so the brain matter shrinks and then when the brain pressure goes up, the arteries in the brain dilate and what is a migraine headache it means, that certain arteries in the brain are dilating too much.

If somebody has a structural cause of their migraines or they have a structural cause of their seizures, movement disorders, blanking out episodes, tremors obviously drugs aren’t going to resolve them because there’s a cervical spine structural problem and ligamentous damage in the neck.

A September 2024 paper in the journal Scientific reports (1) writes: “Migraine is a common bi-directional comorbidity  of epilepsy, indicating potential complex interactions between the two conditions.” (Simply migraines and epilepsy have some type of effect on each other). To try to determine this effect, the researchers used brain morphology analysis They studied the brains of the test subjects) to assess possible interactions between epilepsy and migraine.

This is how they studied the brains of  30 individuals with epilepsy and comorbid migraine without aura (EM – group), along with 20 healthy controls (HC – group) and 30 epilepsy controls (EC – group) without migraine. in comparing compare differences in gray matter volume, cortical thickness, and global level and local level graph theory indexes between the EM, EC, and HC groups to investigate structural brain changes in the comorbid migraine without aura (EM – group) patients.

• Voxel-based morphometry (VBM). This test helps doctors assess brain anatomy differences between study patients
• Surface-based morphometry (SBM). A September 2022 paper in the journal Magnetic resonance in medical sciences (2) suggests Surface-based morphometry is extremely useful for estimating cortical morphology the structure of the cerebral cortex
• and structural covariance networks (SCNs). Simply how certain regions of the brain work together.

The researchers found: “clear differences in brain structure in the comorbid migraine without aura EM patients compared with the control group.” They suggest this as evidence that migraine episodes may influence brain structure in epilepsy patients. Conversely, abnormal brain structure may be an important factor in the development of epilepsy with comorbid migraine without aura. In other words, migraines cause structural changes in the brain that may spark seizures, seizures may cause structural changes in the brain that cause migraines without aura.

An October 2024 study in the journal Medicine (3) examined antiepileptic drugs (AED) which are progressively utilized for off-label conditions other than epilepsy, like bipolar disorder and migraine. The objective of this study was to evaluate current prescribing patterns and utilization of AED in pediatric, neurosurgery, and psychiatry wards and to compare them to the standard treatment guidelines.

In simple terms, were the Antiepileptic drugs helpful in migraine?

• In this study, 223 of 410 patients, 54.3% were male, 45.6% (187 patients) were female, and 63.7% (261 patients) were from the 1 to 18 years’ age group.
• The majority 47.3% (194 patients) were from the pediatric ward followed by neurosurgery 28.7% (118 patients).
  • Among the studied patients, 96.1% of them had comorbid conditions other than epilepsy alone.
  • With regards to types of seizures:
    • unclassified seizures were the most common seizure type (59.8%; 245 patients) followed by generalized tonic clonic seizures 23.4% (96 patients).
    • In this study, the most frequently utilized AED was (Valproate) 59.0% (242 patients) followed by antiepileptic first-generation medicines were commonly used (76.3%).

The researchers found many concerns with this prescription off label use. The research conducted in Pakistan followed the United Kingdom’s National Institute for Health and Care Excellence and found non-compliance in 77.6% of the patients. Nonadherence to National Institute for Health and Care Excellence guidelines may be due to the unavailability of guidelines or the inability of prescribers to make correct diagnoses. Further, 87.6% of patients showed drug interactions with major and moderate drug interactions were more prevalent than minor ones. 

Are Ehlers-Danlos Syndrome Headaches and Migraines Caused by Cervical Spine and Neck Instability?

References

1 Zhang S, Liu W, Li J, Zhou D. Structural brain characteristics of epilepsy patients with comorbid migraine without aura. Scientific Reports. 2024 Sep 10;14:21167. [Google Scholar]
2 Goto M, Abe O, Hagiwara A, Fujita S, Kamagata K, Hori M, Aoki S, Osada T, Konishi S, Masutani Y, Sakamoto H. Advantages of using both voxel-and surface-based morphometry in cortical morphology analysis: a review of various applications. Magnetic Resonance in Medical Sciences. 2022;21(1):41-57. [Google Scholar]
3 Ayaz M, Ali A, Bibi R, Iqbal MM, Iqbal A, Samreen S, Syed W, Khan H, Al-Rawi MB. Retrospective evaluation of prescribing pattern and utilization of antiepileptic drugs in pediatric, neurosurgery, and psychiatry wards: A comparative study to the standard treatment guidelines. Medicine. 2024 Oct 4;103(40):e39818. [Google Scholar]