Clinical Profile of Primary Headache Disorders in Patients with Epilepsy and Response to Standard-of-Care Migraine Preventive Treatment: A South Asian Cohort

For millions of people around the world, the brain is a place where electrical signals sometimes misfire, causing seizures. This condition, known as epilepsy, is often the primary focus of medical care, but it rarely travels alone. Just as a stormy sky often brings both thunder and heavy rain, epilepsy frequently arrives with another common neurological condition: headache. While seizures are dramatic and impossible to ignore, headaches can be a quiet, persistent companion that doctors sometimes miss. Among the many types of headaches, migraine stands out as a specific, throbbing pain that often comes with sensitivity to light and nausea. Scientists have long suspected that these two conditions share a common ground, perhaps because the same overactive electrical pathways in the brain that cause seizures might also trigger migraines. However, while we know they often occur together, we still do not fully understand who is most likely to suffer from both, or whether treating the headache helps the patient feel better overall, especially in regions where large-scale medical studies are rare.

A team of researchers at a major teaching hospital in New Delhi, India, set out to fill this gap by looking closely at the lives of people living with epilepsy. They wanted to know how common primary headaches—those not caused by a tumor or injury, but by the brain's own function—were among their patients. More importantly, they wanted to see what happened when patients who suffered from both epilepsy and migraines received standard preventive treatment for the headaches. The study followed 814 patients over a period of eighteen months. The doctors screened each person to see if they also suffered from a primary headache disorder. They found that nearly half of the patients, specifically 42.5 percent, were living with a co-existing headache. This was a significant discovery, confirming that headaches are a very common companion to epilepsy, yet they are often overlooked in routine check-ups where the focus remains strictly on stopping seizures.

When the researchers looked closer at the types of headaches these patients experienced, a clear pattern emerged. The vast majority of the headaches occurred between seizures, a time doctors call the "interictal" period, rather than immediately before or after a seizure. Among these between-seizure headaches, migraine was by far the most common type, affecting nearly 70 percent of those with headaches. This was a notable finding because, in the general population, tension-type headaches are often more common than migraines. The study also revealed who was most at risk. The data showed that being female and having seizures that were harder to control were the two strongest independent factors linked to having a migraine. Interestingly, the number of medications a patient took to control their seizures did not predict whether they would get a headache, suggesting that the headache was not simply a side effect of the drugs but rather part of the underlying condition.

To see if these headaches could be managed, the researchers focused on the patients who had both epilepsy and migraines. They provided these patients with standard preventive treatments, which included common medications known to help reduce the frequency and severity of migraines. The patients were checked monthly for three months to track their progress. The results were encouraging. Over the course of the study, the number of days patients suffered from headaches dropped significantly, falling from a median of 14 days a month at the start to just 6 days by the third month. The number of days specifically marked by migraine pain also fell sharply, from 4 days a month down to just 1. By the end of the three months, nearly 80 percent of the patients had achieved a reduction of at least half in their headache days. This improvement happened steadily over time, suggesting that consistent treatment can bring real relief.

The study also looked at whether treating the headaches affected the seizures themselves. The researchers found that while the headache relief was dramatic, the change in seizure frequency was much smaller. Most patients in this group already had well-controlled seizures, and the treatment for migraines did not drastically alter the number of seizures they experienced. This distinction is important because it shows that while the two conditions are linked, treating one does not automatically cure the other. The improvement in headaches was a direct result of the specific migraine treatment, not a side effect of better seizure control. The researchers noted that because this was an observational study without a control group, they could not prove that the drugs caused the improvement with absolute certainty, as some patients might have improved naturally over time. However, the steady, progressive nature of the improvement strongly suggests that the treatment was effective.

This work highlights a crucial need in medical care: doctors treating epilepsy should also ask about headaches. For too long, the dramatic nature of seizures has overshadowed the quiet burden of migraines, leaving many patients without relief for a condition that significantly impacts their quality of life. The study confirms that migraines are the dominant type of headache in people with epilepsy and that they respond well to standard preventive care. By identifying the patients most at risk—specifically women and those with less controlled seizures—doctors can be more proactive in screening for these headaches. The findings suggest that a simple conversation about pain, followed by appropriate treatment, can transform the daily lives of people living with epilepsy, offering them a clearer path to a life with fewer headaches.