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Hypothesis on neurophysiopathological mechanisms linking epilepsy and headache
Pasquale Parisi1, Marta Piccioli, Maria Pia Villa
1Child Neurology, Paediatric Sleep Centre & Paediatric Headache Centre, II Faculty of Medicine, La Sapienza University, Via di Grottarossa, 1035-1039, 00189 Rome, Italy. pasquale.parisi@uniroma1.it
Medical Hypotheses
|January 15, 2008
Summary
Epilepsy and migraine share links through cortical excitability. Headache may be the sole seizure symptom, suggesting a need to revise diagnostic criteria for both conditions.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Epilepsy and migraine comorbidity is long-established but poorly understood.
- Both disorders share risk factors, symptoms, and treatments.
- Cortical hyperexcitability is a proposed shared pathophysiological mechanism.
Purpose of the Study:
- To explore the link between epilepsy and migraine through shared mechanisms.
- To investigate the hypothesis of a clinical continuum between migraine and epilepsy.
- To propose revised diagnostic and treatment considerations for patients with both conditions.
Main Methods:
- Review of clinical observations and scientific data.
- Analysis of pathophysiological mechanisms, particularly neuronal hyperexcitability.
- Literature synthesis on the continuum between migraine and epilepsy.
Main Results:
- Evidence supports a clinical continuum, with potential overlap between migraine and epilepsy.
- Headache can be the sole ictal manifestation of seizures.
- Neuronal membrane hyperexcitability is a potential common pathway for both disorders.
Conclusions:
- A unifying hypothesis suggests that various etiological factors converge on neuronal hyperexcitability, manifesting as epilepsy, migraine, or both.
- Diagnostic criteria for headache/migraine may need revision to include ictal epileptic manifestations.
- Careful patient follow-up and a revised concept of seizure control are recommended.
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