Children with epilepsy have more migraines

Children with epilepsy are more likely to suffer from migraine headaches than children without epilepsy, according to a study just published in Neurology by researchers from Johns Hopkins University. Dr. Sarah Kelley and her colleagues studied 400 children who were seen at an epilepsy clinic. They discovered that 25% of children with epilepsy also suffered from migraine headaches. Children aged 10 and older, as well as those with JME (juvenile myoclonic epilepsy) and BECTS (benign epilepsy with centrotemporal spikes) were more likely to have migraines than younger children or those with other types of epilepsy.
Unfortunately, pediatric neurologists who were seeing children who had both epilepsy and migraines (with migraines occurring once a week or more) did not discuss their migraines in half of such cases. Primary care doctors treating adults have also been shown to ignore complaints of migraine headaches in many patients, but in this study doctors were pediatric neurologists and they should know better. The education of all doctors, including adult and pediatric neurologists in the treatment of headaches leaves a lot to be desired. Many prominent neurology programs, including those at Cornell, Yale, NYU, and other medical schools lack a dedicated headache specialist. This is probably due to a combination of factors, including low prominence of headaches as compared to conditions such as epilepsy, Alzheimer’s, strokes, and MS, as well as lack of funding for research and lack of faculty trained in headache medicine.
Parents of children with migraines also sometimes minimize the seriousness of migraine as compared to epilepsy, however migraine is often more disabling than epilepsy, even if it is less dramatic in its manifestations. Migraine is highly treatable condition and children often do very well with biofeedback, magnesium, CoQ10 and other supplements and in case of very frequent attacks, Botox injections. If these, safer treatments fail, medications can be very effective. We use both abortive medications, such as sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert) and other triptan drugs, as well as prophylactic medications, such as beta blockers (blood pressure medications), some epilepsy drugs, and antidepressants (although some antidepressants can make seizures worse). If the pediatric neurologist is aware that the child also has migraine headaches she may decide to use an epilepsy drug that can help both conditions. Migraines improved in about 28% of children in this study when they were prescribed an epilepsy drug, but this number potentially might have been higher if doctors were aware of the migraine diagnosis. None of the children with weekly or more frequent migraines were prescribed a triptan drug.

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