Migraine, Stroke and Epilepsy: Underlying and Interrelated Causes, Diagnosis and Treatment

Opinion statement

Migraine, epilepsy and stroke are highly prevalent neurological disorders, often comorbid. They share diverse pathophysiological mechanisms that explain the use of similar drugs on certain occasions (i.e., the use of antiepileptic drugs in migraine prevention). Migraine with aura represents a risk for ischemic stroke, and avoiding contraceptives, tobacco use, and ergot alkaloids should be advised in those patients. Epilepsy bears a bidirectional relationship with headache. Only three entities are considered as seizure-related headaches: migraine-triggered seizure (migralepsy), hemicrania epileptica, and post-ictal headache. Topiramate (100–200 mg daily) and valproic acid (500–1,000 mg daily) are first-line drugs in migraine prevention, while older antiepileptics have no use in this setting. Stroke is the most common cause of symptomatic epilepsy in the adult. Therapy with lamotrigine, gabapentine, and levetiracetam is advised in late-onset (2 weeks after stroke) stroke-seizures, while early-onset seizures usually do not require therapy.

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Dr. Aida Rodriguez-Sainz reported no conflicts of interest relevant to this article.

Dr. Ana Pinedo-Brochado reported no conflicts of interest relevant to this article.

Dr. Jose L. Sánchez-Menoyo reported no conflicts of interest relevant to this article.

Dr. Javier Ruiz-Ojeda reported no conflicts of interest relevant to this article.

Dr. Ines Escalza-Cortina reported no conflicts of interest relevant to this article.

Dr. Juan Carlos Garcia-Monco reported no conflicts of interest relevant to this article.

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Correspondence to Juan Carlos Garcia-Monco MD.

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Rodriguez-Sainz, A., Pinedo-Brochado, A., Sánchez-Menoyo, J.L. et al. Migraine, Stroke and Epilepsy: Underlying and Interrelated Causes, Diagnosis and Treatment. Curr Treat Options Cardio Med 15, 322–334 (2013). https://doi.org/10.1007/s11936-013-0236-7

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  • Stroke
  • Migraine
  • Epilepsy
  • Seizures
  • Vascular epilepsy