Migraines with aura mimic temporal lobe epilepsy

[Endless]

For those who have had temporal lobe seizures but no positive eeg during a seizure event, here's some interesting information.

Many people with epilepsy also suffer from migraines. But I was surprised to read that many episodes that seem like Temporal Lobe siezures can actually be Migraines. That includes visual, smell, and audio hallucinations, Deja or Jamais Vu, psychic/religious experiences, altered consciousness, speech problems like aphasia, Alice in Wonderland Syndrome, and many, many more.

There doesn't have to be a headache. There are "silent migraines" that have an aura, but no pain.

Some migraines even have altered consciousness, where a person looks conscious, but isn't. (sound familiar? like maybe the same as a complex partial seizure?)
http://www.cjem-online.ca/v6/n6/p451
http://www.netplaces.com/migraines/beyond-migraine-comorbidities/epilepsy.htm
http://www.medindia.net/education/familymedicine/EvaluationofHeadache-Clinicalmanifestations.htm

To make it even more confusing there can also be an overlap between epilepsy and migraines, making it hard to tell what's what. A positive eeg during an episode is one of the only ways to be totally sure. Another is by differential diagnosis criteria.


If you've had multiple temporal lobe siezures with no positive EEG during an episode, migraine with aura is worth considering. And a very good headache neuro is needed to help determine which of your episodes are seizures, and which are migraine.

According to the Migraine Aura Foundation:

Transitory aura symptoms

Auditory aura symptoms
Body image distu...
Size of the body
Mass of the body
Shape of the body
Position of body in space
Depersonalization and der...
Dreaming disturb...
Perception of the pain of nocturnal migraine attacks during dreams
Unusual powerful, vivid or weird dreams associated with migraine headaches
Nightmares associated with migraine headaches
Recurring dreams as migraine aura experiences
Migraine aura symptoms experienced whilst dreaming
Other disturbances of dreaming associated with migraine
Felt presences
Forced reminiscence
Gustatory aura symptoms
Language symptoms
Motor symptoms
Olfactory aura symptoms
Other disturbances of hig...
Paramnesias
Déjà vu
Jamais vu
Sleepwalking
Somatosensory symptoms
Speech symptoms
Synaesthesia
Time perception disturban...
Visual hallucina...
Random form dimension
Line form dimension
Curve form dimension
Web form dimension
Lattice form dimension
Tunnel form dimension
Spiral form dimension
Kaleidoscope form dimension
Complex visual hallucinations
Visual illusions
Autokinesis
Cinematographic vision
Corona phenomenon
Diplopia
Dysmetropsia
Facial metamorphopsia
Illusory visual splitting
Metamorphopsia
Mosaic illusion
Polyopia
Tilted vision, inverted vision and other forms of illusory rotation
Visual perseveration
Visual loss
Persistent aura symptoms
Psychological experience

Here's more on migraine types. Check them out. See if anything looks familiar.
http://emedicine.medscape.com/article/1142731-overview
http://en.wikipedia.org/wiki/Familial_hemiplegic_migraine

 

[CPD09]

I'm relieved to have come across this in a Google search tonight. For the past 2-3 months I have been experiencing migraine auras with occipital and temporal symptoms. My visual symptoms include the segmented, worm-like formations that resemble eye floaters and visual snow with the temporal symptoms including jamais vu, derealization, depersonalization and slight aphasia from time to time. The world and my family and friends just seem strange and distant to me. I also have vivid dreams every night and tinnitus occasionally.

The thing with my auras though is that they're persistent. I experience these symptoms 24/7 and it's become pretty unnerving. I'm extremely lucky that my dad is a neurologist, so I've had every test imaginable to determine what's going on. An MRI and several EEGs showed no abnormalities or seizure activity, so after doing some research with my dad we came across persistent aura without infarction. My father found that Lamictal has been successful in treating persistent migraine aura, so I've started that but haven't titrated up to the therapeutic dose yet. I'm hoping that it will help because I'm tired of these persistent auras. I could deal with the visual symptoms, but the temporal symptoms really get in the way of my general function and interaction with people. Plus, I'm wanting to go back to school soon, so I don't need these symptoms hindering my learning abilities.

 

[Endless]

CDP,

I hope the Lamictal does it for you and you are symptom free soon! Both migraines and seizures change a person's life.

It makes me happy to hear this post helped you out. The above knowlege helped me, too.

I think the public perception of migraines doesn't match the disease. People don't know it can mess with your head and have so many symptoms that others find unusual/strange. Someone that helped out was that reporter that had an on-camera episode. It was all over the news for awhile. She had aphasia, and had a diagnosis of migraine with aura. It was hard for me to believe that diagnosis. I thought it was for sure epilepsy. But that just shows the misperception about the disease and the need for education. Now I understand more about the diagnosis and why it was right.

All this gets really messy, because epilepsy and migraine have a high degree of comorbidity. In other words, people with epilepsy are much more likely to have migraines as well. It takes very good neurologist to help tell which are which - migraines or temporal lobe seizures. I have both. Since my auras can be quick (1-3 minutes) or long (days) or somewhere inbetween, that's some help in telling what's a seizure and what's a migraine aura, but there are still a lot of gray areas. It really is hard to figure it all out.

The good news is that some seizure drugs are also used to treat migraines, so it should help with either one. But I'm on 400mg of Lamictal and migraine auras and seizures are still a problem. I'm hoping the seizures are under control but it's hard to tell, given the overlap in symptoms. It's hard to tell. The doc thinks the complex partials are seizures, the rest of the episodes maybe migraine. But who knows. We are going to try another drug on top of the lamictal.

You are lucky to have your dad!

 

[k2s4ever]

What an awesome post. I have been having the olfactory and gustatory auras (they coincide) for almost 5 years, and have been monitored by a neurologist almost 3 years. Initially there was speculation I had SPS. The auras increased in number, and as I've noted all along, the burn smell and taste persist the entire day, and on occasion up to 48or more hours. Not once have I ever lost consciousness/awareness, or anything remotely similar. As this persisted and I noted that I also had vague headaches along with a history of about once a year at times real killer headaches with nausea and vomiting, then the idea of migraine aura came about, like an atypical migraine disorder, because I'm not totally absent of headaches. The vague headaches I get are manageable and not impairing. I actually am now going back to the ENT again at the neuro's request because he is beginning to wonder if my olfactory aura is something in that realm again. However, I remain on Lamictal and Keppra. The Lamictal he said has some note of being helpful with auras, so I'm still on it. (Depakote ER and Topamax were tried as a dual medication to address if it was SPS or migraine. Depakote helped but didn't eliminate-so he tried Topamax, and I had wicked muscle spasm side effects and refused to continue, so then he switched me to Lamictal). A recent decrease in the Keppra though has triggered a bunch more episodes. I'm never free of the aura, but it's usually about 7 per month, but it syrocketed since that Keppra was lowered, and since my rx still is for the original, I put myself back on the dose and saw immediate improvement, and then a few days later started having a daily aura again but oddly without affecting my taste. This occured for a week and then yesterday back to the same very noticeable burn smell and taste issue. Today, poof, off it went again, business as usual, HOWEVER, today I had for the first time what I believe is a scotoma. In my peripheral vision, I saw a bright white zig zag formation almost immediately at the same time as the olfactory aura kicked in. It was sparkly. I've had sparkler type things before with no pain and they disapper fast. This zig zag thing persisted for about 5 minutes or so, and I could see it with my eyes open but it didn't terribly impair my vision although I could still make it out. I have never seen that zig zag before, but by all accounts, I can well guess it is the scintillating scotoma that is seen in migraine. This leads me to really believe my issue has in fact been migraine only all along. I will report this in a month at my next check up. It gives me hope that finally this can be the area of focus so that I can minimize how many I get of these. I don't know what else is used for migraine that is predominantly aura. The other migraine meds are ones taken I believe to get rid of the headache as opposed to prophylactic. I don't need a headache medicine-the killer headache I get is once every so often, and I just have to take an NSAID rx dose, go to sleep for about 2 hours, and while I feel worn out, the headache is gone and I can eat again. So the severe ones are not frequent enough. The vague ones don't disable me-they just are annoying and I guess I do get more tired, but I don't even take Ibuprofen or anything for them as I am trying to not overload on NSAIDs. I wonder if they are in fact migraines-my guess is probably. Migraine is an overused term. A lot of people say they have them and I wonder if they're formally diagnosed. I can bet now though that I have a discernible scotoma occurence, my neuro will agree it's likely migraines. And then a plan of attack from there works for me. At this point, I am convinced that I never had SPS, but one of the small few that have the olfactory aura from migraine.

 

[Endless]

K2,

Many of the seizure meds also work as a migraine prophylactic. My headache neurologist says Lamictal is sometimes used off-label for that purpose. Even though the literature doesn't say Lamictal works to prevent migraines, I think it's because it hasn't been studied for that effect.

The following AEDs are used to prevent migraines. I think Topamax and Depakote are the only two approved by the FDA for that purpose, but don't quote me on that. Livestrong and the NY Times aren't what I'd call the most reliable sources. They just happened to pop up first in the search.


Here's the list of AEDs used to prevent migraines, including those that are sometimes used off-label.

• Keppra
• Topamax
• Depakote ER
• Lamictal
• Valproate
• Neurontin
• Lyrica

http://www.livestrong.com/article/219947-how-to-use-keppra-in-the-treatment-of-migraines/
http://health.nytimes.com/health/gu...ications-for-preventing-migraine-attacks.html

You are smart not to overload on painkillers of any kind - including the range of meds from tylanol to oxycodone. Taking them more than about 2 days a week can result in rebound headaches that can be equal to or worse than the original headache itself. And rebound headaches can happen on a daily basis, not just once in awhile. Too many NSAIDs long term are also bad for your kidneys. It's why people who have them prescribed have blood tests every so often.

.

 

[k2s4ever]

Thanks again Endless! It's relieving to see Keppra on that list! Cause man, when the dose was lowered, those auras escalated from my now all time low of 3-4 in a month to daily. Then as soon as I increased the dose up, I had a break, followed now by getting the aura almost every day but a definite change in that my taste is now not affected. However, Keppra ALONE does not help decrease anything, only when a second medication was added. The burn smell has also been fainter, but today it went poof, but upon later inspection, my taste today also was not affected, so something has shifted, but having my taste not affected is definitely an improvement! And today, the shimmery white zig zag pattern, that totally has to be a migraine visual aura. The olfactory and visual auras occured almost simultaneously. The olfactory one might have been a second ahead at best, but for intensive purposes, it was the same time. And now the very random sparkly diamond floating things I've seen before all my life, same shimmery white color as the zig zag, they last just seconds and I never have any after effect or other aura with it. I always just disregarded those, assuming it was a harmless optical anomaly. But I just bet they're related to all of this. I can go a year or two without them. This zig zag thing today I could see it on the wall in my field of vision, but not anything that would affect me being able to carry on normal activities, and no other issues like slurred speech- I just carried on like nothing doing. I am wondering what dose of Lamictal is considered for migraine prophylaxis, as it's not officially used for that. (I take 150 mg daily )But I feel it could help, and already, the taste component has leveled off in the last week, so I'm half inclined to leave it alone and be thankful. I have to still get the updated ENT exam as neuro really does now ponder that this isn't a neurological issue, but look at the aura increase with the Keppra dose lowered, and look at the scotoma I had today, unlike anything I've had before, but occuring at the same time as the olfactory deal, but now taste stays normal. Weird for sure, but has to be neurological, and seems migraine.

 

[momof3boys]

You know whats weird is that I was put on Keppra at around the age of 18. Shortly after then, carbatrol was added. I was on those two medications together for over 12 years. But during that time period, I had terriable headaches! I had them so often, we didnt know what was going on! It wasnt til we met my neurologist Im seeing now, in Novmeber 2010 when I brought these up to him. He changed me from Keppra to Keppra XR and Ive had no more headaches or migraines since! I dont know how in the world we were never told this before, but I thanked him so much for changing my life! It seriously made me feel like a new person, just changing from Keppra to Keppra XR!

 

[k2s4ever]

momof3boys:
Hmmm-Keppra XR might be worth a look. Keppra alone did nothing for the olfactory auras, but man, when the dose was lowered, I sure got worse, so it has to be doing something. It's clear that I do better with a 2nd medication added. And this weirdness continues. I am now having the olfactory aura every day after the three day break when I went back up on the Keppra. But my taste is fine, which represents a significant change. The olfactory aura is there, but not as strong, and I can basically live with this, so I half don't want to mess with this, because I'm the best I've been in a long time. I still get some of the vaguer headaches, but able to deal. So guess we'll see.