What Is Migraine Seizure?

Relationship between migraine and seizure

Migraines and seizures both result partly from abnormal electrical activity in the brain. They are episodic disorders that partly occur due to hyperexcitability in susceptible brain regions.

This neocortical hyperexcitability transitions to hypersynchronous neural firing resulting in seizures. However, in migraines, the excitability transitions to cortical spreading depression (CSD). In both conditions, a stressor that the brain would usually handle becomes too exciting for a migraineur or someone susceptible to seizures.

The knowledge that neuronal hyperexcitability is the initiating factor in both events has led to the development of epileptic drugs that treat migraines and deal with seizures. Further research is still ongoing to discover additional commonalities in the initiation of both attacks and, as a result, develop drugs that can treat them.

How does a migraine trigger a seizure?

A migraine triggers a seizure if the latter occurs during or within an hour of the migraine with aura. This condition is referred to as migralepsy or migraine aura-triggered seizure and should not be confused with a seizure-induced migraine since. In this instance, it is the migraine that causes the seizure and not vice versa.

You will present with aura symptoms at the onset of a migralepsy, including throbbing head pain, sensitivity to light and sound, dizziness, weakness, and neck pain. The aura then triggers a seizure, where you may exhibit diminished awareness and involuntary body movement. You are unlikely to remember the details of this episode after regaining consciousness from the seizure.

The mechanisms responsible for this occurrence are unclear, although researchers speculate that distinctive blood flow changes during migraine with aura may trigger the seizures.

Migraine types and seizures

There are various migraine types, but not all of them are associated with a seizure.

Migraine with aura

A migraine with aura is one where you experience sensory disturbances, such as:

• Seeing flashing light (scintilla)

• Prickling or tingling sensations in your hands or feet (paresthesia)

• Seeing zigzag patterns (fortification spectra)

• Loss of vision

Migraines with aura can sometimes trigger a seizure or are associated with one, a condition called migralepsy. If you experience a migraine seizure, you are likely to exhibit symptoms such as:

• Diminished consciousness

• Weakness on one side of the body

• Involuntary body movements

• Difficulties in speech

Vestibular migraine

Vestibular migraine¹ affects the vestibular system, a sensory apparatus of the inner ear that helps the body maintain balance and spatial orientation. Vestibular migraines, therefore, cause vertigo, a spinning sensation that makes you feel dizzy and off-balance.

While vertigo can spell the onset of seizures, in conditions such as vertiginous epilepsy², vestibular migraines do not occur as part of a seizure. Neither do seizures trigger this form of a migraine.

Visual migraine

Visual migraine is the collective term describing migraine subtypes that cause visual disturbances. 

Types of visual migraines include:

Retinal migraine

This condition is accompanied by transient vision loss or temporary diminished vision in one eye. However, these bouts of vision loss may sometimes precede the actual migraine.

Migraine with aura but without pain

This refers to a condition where you experience a migraine aura without headaches. You will thus present with visual disturbances such as seeing colored spots, flashing lights, and zigzag lines, but the symptoms will be devoid of head pain.

Migraine with aura

Individuals with this migraine experience visual disturbances accompanied by headaches.

As earlier stated, migraine aura symptoms can trigger seizures, a rare condition known as migralepsy. However, migraines without aura cannot cause seizures.

Migralepsy is difficult to diagnose since there has to be evidence that the aura resulted in the seizure and was not merely a preceding symptom, or that the aura was not a seizure in and of itself, and the headache a postictal sequela.

Hemiplegic migraine

It is a rare subtype of migraine with aura in which you feel a temporary weakness on one side of the body, be it the face, arm, or leg. You could also experience transient motor weakness resulting from unilateral paralysis or numbness affecting the arm or leg on one side of the body.

The vision, speech, and sensory impairments in migraine with aura also manifest in individuals with this condition.

Hemiplegic migraine is a subtype of migraine with aura and, therefore, could, in rare instances, be associated with or trigger a seizure.

Symptoms of migraine seizure

If you have a migraine seizure, you are likely to exhibit symptoms such as a visual aura accompanied by nausea and vomiting. You will then present with symptoms characteristic of epilepsy, such as impairment or loss of consciousness and involuntary muscle movement.

However, visual seizures are sometimes mistaken for migraine auras as occipital seizures can sometimes imitate migraine auras. This increases the probability of misdiagnosis.

Risk factors of migraine seizure

Since migraine seizures result from migraines with aura, some factors that may predispose you to experience migraine with aura include:

Sex

Migraines, including those with aura, are more common in women than men.

Family history

If migraines run within your family, you could probably experience the same.

Age

Migraines begin in the teen years and are likely to increase as you grow older, particularly in your 30s.

However, being at risk of experiencing migraine with aura does not mean that the condition will trigger a migraine seizure. You would also have to be at risk of having a seizure for that to occur.

Some risk factors for developing a seizure include:

• Genetics

• Prior head trauma or CNS infection

• Known neurologic disorders

• Drug use or withdrawal, particularly of recreational drugs

• Alcohol withdrawal

• Nonadherence to anti-seizure drugs

• Family history of seizures or neurologic disorders

• Alzheimer

• Stroke

• Hematologic Dx

• Rheumatologic Dx

• History of cancer

How can you prevent migraine attacks?

Migraines affect approximately 12%³ of the US population, but while it is this common, there are measures you can take to reduce the chances of experiencing one.

Lifestyle changes

Avoidable triggers such as stress, particular foods, inadequate sleep, changes in weather, and even particular medications are often responsible for most migraines. Managing these causes can thus save you a migraine episode.

For instance, you can prevent migraines that result from stress by equipping yourself with better ways to handle the rigors of life, either by having an optimistic outlook on situations or taking breaks to put your mind at ease. Managing your time and organizing tasks can help increase your efficiency and effectiveness, reducing the toll your work takes on your mental health.

Also, remember to engage in fun activities every once in a while.

Dietary choices also play a role in migraine prevention. Fermented foods, chocolates, alcohol, and aged cheese are some foods that trigger migraines in some people. If this applies to you, it is best to avoid these edibles and seek alternative forms of sustenance that do not have the same effect.

Given that hunger can also trigger a migraine, keeping yourself nourished by eating at regular hours is advisable.

If weather changes trigger your migraines, you could prevent them by choosing to remain indoors if you can afford it. This will save you the excessive heat, high humidity, or bright sunlight that could result in your condition. 

Also, ensure that you get a good night's sleep every day. One way to do this is by developing regular sleeping hours and avoiding disruptions, such as light or noise, that can keep you awake or interrupt your sleep.

Other prevention strategies

You could also opt for prophylactic migraine treatments, such as:

• Beta-blockers

• Calcium channel blockers

• Antidepressants

• Anticonvulsants

However, you should not take these drugs without a prescription, as they are primarily meant for other ailments you may not be experiencing.

You can also avoid stimuli that trigger migraines, such as loud noise and bright lights, as a prevention strategy. Being aware of hormonal changes can also help you ease the migraine symptoms before they progress further.

When to visit a doctor

Migraines do not always indicate an underlying condition. They also subside after some time, either on their own or after taking medication. However, if they recur over time and you experience the following symptoms, it is wise to visit a doctor.

• Blurry vision, double vision, or blind spots

• Difficulties with speech, seizures, confusion, and changes in personality

• Motor weakness, dizziness, sudden loss of balance, numbness or tingling

• Severe nausea and vomiting

The lowdown

Migraines and seizures stem from hyperexcitability of the brain. The difference is that when hyperexcitability results in cortical spreading depression, migraines occur, while seizures ensue when the excitement causes hypersynchronous neural firing.

However, a migraine with an aura can trigger a seizure during or within an hour of developing the migraine. 

You will likely exhibit diminished awareness, involuntary movements, and speech difficulties when you experience a migraine seizure. Still, you should not mistake migraine seizures for migraines that occur as a seizure symptom. Seizure-induced migraines are not responsible for triggering the attack but may rather occur because of it, although this too is highly debated.

While migraine seizures are rare, you are better off taking preventive measures, such as lifestyle changes to minimize migraines. 

If migraines persist and accompany other severe symptoms such as difficulties in speech, visual aura, and motor weakness, it is best to visit a doctor for a proper diagnosis.