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Clearly, migraine is not the same as epilepsy. But are they connected?

 

Clearly, migraine is not the same as epilepsy. But are they connected? 

Sometimes, headaches are not the whole picture. Comorbidities – existing or underlying conditions – are especially common when headaches are chronic or severe. (For more about comorbidities in tension-type headaches, have a look at this article. For more on the links between migraines and strokes, look here.) There is a large body of medical research on how neurological disorders in particular often seem to overlap. One particularly interesting possible connection is between migraine and epilepsy.


Migraine and epilepsy: statistical overlaps

Do people with migraines have a higher risk of epilepsy? And what about the other way around: Do people with epilepsy suffer from migraines more often? A British and Dutch research team conducted a comprehensive review of multiple studies investigating the links between migraine and epilepsy. The consolidated data from the various studies showed a 52% increase in migraine prevalence among people with epilepsy compared to people without epilepsy. Among people with migraines, the rate of epilepsy was 79% higher than in people without migraines.


Is there a shared pathophysiology?

The authors believe genes may be part of the reason for the strong association observed in their review. Over the years, scientists have discovered several genetic factors that show up in both conditions. Another possible connection lies in what’s called cortical spreading depression (CSD) – a wave of electrical activity that moves across the brain during a migraine attack (take a look at this article). Researchers suspect that similar processes might also play a role in epilepsy. When scientists examined patients’ brain activity in detail, they found evidence that this hyperexcitability – the brain’s tendency to become overly reactive – could be involved not only in migraines but also in the neural activity that triggers epileptic seizures.

If it turned out that the same underlying mechanisms are at work in both disorders, then migraine and epilepsy could have a common origin – a shared pathophysiology. There is another finding which supports this idea: people who have both migraine and epilepsy tend to experience more severe symptoms and a poorer prognosis than those with epilepsy alone.


A challenge for research

Despite these findings, researchers face an obstacle: the available studies on migraine and epilepsy are hard to compare. Different research teams use different diagnostic methods to verify whether participants truly have migraine, epilepsy, or both. This lack of consistency makes it difficult to make comparisons and draw reliable conclusions about how the two conditions may be related. The authors accordingly emphasize the need for further studies using standardized methods to provide a solid basis for comparisons and reliable results.


Is there a connection in terms of timing?

To understand more about possible overlaps between migraine and epilepsy, researchers have also looked at when headaches occur in relation to epileptic seizures, and vice versa. In one study with over 500 epilepsy patients, scientists asked when headaches occurred and what kind of headaches they were. Most participants had focal epilepsy, which affects around 400,000 people in Germany. In this form of epilepsy, a seizure starts in one part of the brain but can spread to the rest of it.

In more than three-quarters of participants (78%), the headaches occurred after the seizure. About 43% reported experiencing headaches between two separate seizures. "Postictal" headaches (occurring after a seizure) typically begin within three hours after the epileptic seizure and can last up to three days, although their duration is much shorter in most cases. The most common type of headache in this patient population was tension-type headache (around 35%). Around 12% had migraine attacks.


Why is there a connection in terms of timing?

When it comes to understanding why epileptic seizures and headache attacks sometimes occur in close succession, researchers are once again entering the realm of informed speculation. Research into the root causes so far has merely identified potential factors that might be involved in the underlying disease mechanisms. It seems clear that, after a seizure, blood vessels in the brain widen, changing blood flow in the affected area. Researchers believe that this might help trigger a migraine attack.

Another clear connection is the aforementioned shared hyperexcitability in the brain’s cortex. This could mean that one event (a seizure or migraine) can trigger or increase the likelihood of the other. Some scientists also suspect that the trigeminal nerve may be involved. This nerve supplies sensory information to large areas of the face and has long been considered a key player in the development of migraine attacks. Finally, there are probably genetic factors that contribute to both disorders – either as direct causes or as modifiers that influence the disease processes involved. What scientists do agree on is this: a great deal more research will be needed to gain a clear understanding of all the underlying connections.

 

Published: October 2025

 

  • Bauer PR, Tolner EA, Keezer MR, Ferrari MD, Sander JW. Headache in people with epilepsy. Nat Rev Neurol. 2021 Sep;17(9):529-544. doi: 10.1038/s41582-021-00516-6. Epub 2021 Jul 26. PMID: 34312533.

    Chen Y, Wang C, Zhang H, Zheng Y, Cheng W, Wang Y, Lian Y. The characteristics of headache in patients with epilepsy. Cephalalgia. 2025 Jul;45(7):3331024251352855. doi: 10.1177/03331024251352855. Epub 2025 Jul 24. PMID: 40702990.

    D'Agnano D, Cernigliaro F, Ferretti A, Lo Cascio S, Correnti E, Terrin G, Santangelo A, Bellone G, Raieli V, Sciruicchio V, Parisi P. The Role of the Autonomic Nervous System in Epilepsy and Migraine: A Narrative Review. J Integr Neurosci. 2024 Jul 9;23(7):128. doi: 10.31083/j.jin2307128. PMID: 39082300.

    Demarquay G, Rheims S. Relationships between migraine and epilepsy: Pathophysiological mechanisms and clinical implications. Rev Neurol (Paris). 2021 Sep;177(7):791-800. doi: 10.1016/j.neurol.2021.06.004. Epub 2021 Jul 31. PMID: 34340811.

    Ekstein D, Schachter SC. Postictal headache. Epilepsy Behav. 2010 Oct;19(2):151-5. doi: 10.1016/j.yebeh.2010.06.023. Epub 2010 Sep 9. PMID: 20829119.

    GBD Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health. 2025 Mar;10(3):e203-e227. doi: 10.1016/S2468-2667(24)00302-5. Epub 2025 Feb 24. PMID: 40015291; PMCID: PMC11876103.

    Keezer MR, Bauer PR, Ferrari MD, Sander JW. The comorbid relationship between migraine and epilepsy: a systematic review and meta-analysis. Eur J Neurol. 2015 Jul;22(7):1038-47. doi: 10.1111/ene.12612. Epub 2014 Dec 11. PMID: 25495495.

    Keezer MR, Sisodiya SM, Sander JW. Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurol. 2016 Jan;15(1):106-15. doi: 10.1016/S1474-4422(15)00225-2. Epub 2015 Nov 6. Erratum in: Lancet Neurol. 2016 Jan;15(1):28. PMID: 26549780.

    Schiller K, Rauchenzauner M, Avidgor T, Hannan S, Lorenzen C, Kaml M, Walser G, Unterberger I, Filippi V, Broessner G, Luef G. Primary headache types in adult epilepsy patients. Eur J Med Res. 2023 Jan 27;28(1):49. doi: 10.1186/s40001-023-01023-8. PMID: 36707895; PMCID: PMC9881350.

    Zhang S, Liu W, Li J, Zhou D. Structural brain characteristics of epilepsy patients with comorbid migraine without aura. Sci Rep. 2024 Sep 10;14(1):21167. doi: 10.1038/s41598-024-71000-6. PMID: 39256409; PMCID: PMC11387786.

    Zhang S, Lv Z, Li J, Zhou D. Clinical characteristics of headache related to epilepsy: experience from a tertiary epilepsy center. BMC Neurol. 2025 May 26;25(1):223. doi: 10.1186/s12883-025-04217-1. PMID: 40420007; PMCID: PMC12105137.

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