Epilepsy Talk

NEW migraine relief! | August 19, 2022

Your head is throbbing, pulsing, pounding, light is blinding, you want to puke, you can’t think straight. Sound familiar?

Welcome to the miserable world of migraines.

Let’s face it, having migraines is a wretched experience.

Add severe pain, distorted visual images, sensitivity to light, sound, or odors, and maybe even the feeling of numbness in parts of your body. The list is endless.

You may be “lucky” and have migraines once a year. Or like many others, you may suffer one every day for several weeks at a time.

In fact, migraines and epilepsy are sort of kissing cousins. Like seizures, migraines can be triggered by stress, fatigue, flashing lights, loss of sleep, menstruation, and alcohol.

Red wine, caffeine withdrawal, stress, and skipped meals are also among the common culprits. But like epilepsy, avoiding these triggers are easier said than done.

In general, migraines do not cause seizures. Migraines and seizures are two different neurological problems that have overlapping symptoms.

However, people who have migraines are twice as likely to have seizures.

Migraines may have an effect on the appearance of seizures. Researchers haven’t ruled out that these conditions appear together by chance.

Additionally it is no coincidence that there are epilepsy drugs that are actually effective in the treatment of migraines.

Research shows that Depacon (Valproate) and Topamax (Topiramate) are effective in treating migraines and epilepsy. And each has FDA approval for treating them together. 

Depakote (Divalproex Sodium) also works for both, creating a therapeutic “two-fer.”

There are also several other anti-epileptic drugs that have also been shown to lessen migraine headaches – such as Neurontin (Gabapentin), Keppra ( Levetiracetam) and Zonegran (Zonisamide).

However, the dose of AEDs in the treatment of migraines is usually lower than that used for epilepsy.

Let’s say you go the “safe” route and just have caffeine or take Excedrin. If you do more than two days per week on a chronic basis, you may end up with analgesic over usage or “rebound” headaches.

The latter are caused by the brain becoming “sensitized” by the caffeine, aspirin or acetaminophen so that you develop daily or near daily headaches as a result of taking these.

Also, for older adults, pain relievers such as ibuprofen (Advil and generic), naproxen (Alieve and generic), or aspirin, can have side-effects that include dizziness, cognitive issues, and increased risk of gastrointestinal bleeding.

It’s like adding fuel to the fire.

New and exciting interventions

Over the past five years, a handful of new drugs and devices have been approved for prevention and acute treatment of migraines.

“Many of these drugs block the activity of a pain-related protein called C.G.R.P.”, Dr. Seniha Ozudogru, a neurologist at Penn Medicine explained.

These include, for migraine prevention, monoclonal antibodies that are periodically injected or administered intravenously.

There are also pills, called gepants and ditans (with brand names like Nurtec ODT, Ubrelvy and Reyvow). These can be taken at the onset of migraines to block the activity of C.G.R.P.

Rimegepant (Nurtec ODT) has been approved by the F.D.A. to both prevent and treat migraines, Dr. Ozudogru said. Which is notable because most drugs do only one or the other.

“These drugs don’t seem to have significant side effects”, Dr. Robert Cowan, director of the Stanford Headache Program, said.

Because they can cause mild nausea, they aren’t usually prescribed until after a person has tried several first-line treatments. “That’s in large part because the new drugs are expensive,” he said.

Dr. Ozudogru said “some doctors are also cautious about trying the latest treatments because they are so new, and nobody can say how safe they are over the long-term.”

Several medical devices have also been approved in recent years to manage migraine. “These have good data,” Dr. Cowan said, “and they are ideal for people who can’t tolerate medicines or are pregnant.” 

Gammacore, a handheld device, targets the vagus nerve in the neck. Nerivio, a smartphone-controlled device worn on the arm, uses electrical signals to disrupt pain pathways. Cefaly stimulates the trigeminal nerve on the forehead, and Relivion stimulates the trigeminal and occipital nerves.

“Although these newer devices and treatments are promising, many patients struggle to get them covered by health insurance”, Dr. Mazuera said. And they can be pricey: The list price for some monoclonal antibodies is more than $650 per monthly injection, and the Cefaly device costs $379.

However, the Coalition for Headache and Migraine Patients, or CHAMP, has guides available to help patients navigate treatment costs using pharmaceutical company savings cards and financial assistance plans; and the Patient Advocate Foundation has resources available for handling insurance denials and appeals, among other things.

“Migraine is debilitating, and it can be quite difficult to treat. But patients shouldn’t lose hope,” Dr. Ozudogru said.

When she sees a new patient with migraine, she reassures them: “I’m not going to give up,” she says. “We’ll keep trying.”

And today, there are more treatment options than ever to choose from.

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Resources:

https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201

https://www.healthline.com/health/migraine/migraine-and-seizure#How-Are-Migraines-Diagnosed?

https://www.epilepsy.com/article/2014/3/seizures-and-headaches-they-dont-have-go-together

https://www.medicinenet.com/migraine_and_seizures_symptoms_and_signs/article.htm

https://www.brainfacts.org/thinking-sensing-and-behaving/pain/2018/are-migraine-and-seizure-related-080218

https://www.consumerreports.org/headache/healthier-ways-to-handle-a-headache/

http://www.columbia.edu/cu/record/archives/vol20/vol20_iss16/record2016.15.html

https://www.everydayhealth.com/specialists/headaches-and-migraines/treating-seizures-and-migraine/

https://www.healthline.com/health/migraine/migraine-and-seizure#How-Are-Migraines-Prevented?

https://www.nytimes.com/2022/07/14/well/live/migraine-symptoms-treatment.html

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