Successful Opioid Monotherapy in Migralepsy: A Case Series

Background: There is a consensus that migraine and epilepsy are comorbid conditions. The novel concept explored and developed in this case series is that of the primacy of headaches in generating seizures in those patients suffering from migraine-triggered epilepsy (i.e., migralepsy). As demonstrated in the five cases descried here, much like the effect of ketogenic-diet on migraine-triggered epilepsy, once the migraine headaches were completely suppressed after adopting daily scheduled opioid therapy the seizures stopped from occurring, but they returned with the recurrence of the migraines once the patients had stopped their daily opiate regimen for any reason. Clinical implications: The above pharmacological scenario is reminiscent of a similar but naturalistic course of events as described in reports concerning the salutary effects of ketogenic diet, or restoration of sleep, in cases of migraine-triggered epilepsy. In all three instances it is the migraines that drive epilepsy, not the other way around, as it is commonly assumed. Conclusion: Although epilepsy is the more impressive aspect of migraine-triggered convulsions, the cases described in this report point to the primacy of migraine in bring about the whole picture from the start. In every case, seizures were controlled by adopting a treatment plan for preventing the migraines from occurring in the first place, i.e., the daily scheduled opioid treatment for refractory chronic headache. Given the role of cortical spreading depression (CSD) in the genesis of migraine and epilepsy, it is suggested that opiates suppress the development of CSD, thereby prohibiting the progression of migraine to epilepsy.