Author Login

Correspondence to Author: Iraj Derakhshan, 

Cincinnati and Case Western Reserve and Cincinnati Universities, Ohio, USA

Abstract:

Epilepsy and migraine are both episodic disorders, however there is controversy over the exact mechanism that links them. While there are limited publications on the preventive use of opioids in preventing both migraine and epilepsy (migralepsy) that has been shown to be resistant to the use of standard anticonvulsants, the effect of maintenance opioid in preventing migraine and related entities is also well recognised. Here, I give information about a patient with refractory migraine who reacted well to a daily opioid regimen and eventually experienced a complete remission of migraines and seizures while taking a high dose of oxycodone.

Case Report: At the age of 61, Betty (not her real name) was first observed in 2007. She complained of migraine-like headaches, back pain, and nocturnal upper extremity numbness that was perhaps caused by carpal tunnel syndrome. He began experiencing right-sided headaches in 1999, along with photophobia and nausea. She was first given gabapentin, then valproate, neither of which provided sLJnLficDnt relief at the sLJnLficDnt doses. But according to a headache journal she kept throughout her time at my office, she responded to topiramate with significant reduction in the intensity of the headaches, even if they occasionally still occurred. A neurological evaluation and a brain CT revealed no abnormalities. The headaches then subsided while using topiramate, hydrocodone, and triptans. But eventually, she was started on oxycodone-based daily opiate treatment for migraines. The dose was gradually increased to provide total headache relief. She needed the dosage to be progressively increased to 30 mg, taken as two tablets, three times per day. Surprisingly, it was at this high level that not only did the migraines stop happening, but also the rare seizures she had been having; the seizures she had before typically happened after a protracted migraine headache. I unintentionally ran into Betty at a social event where she was talking about how she couldn’t find a doctor to write her an oxycodone prescription, therefore her headaches and seizures had returned. Therefore, the case study in this paper is comparable to five other cases that were recently reported and all of whom used the aforementioned regimen to completely eliminate their headaches and epilepsy.however oxycodone was prescribed to her as part of a daily opioid treatment plan for her migraines. The dosage was gradually increased to provide total headache relief. She needed the dosage to be progressively increased to 30 mg, taken as two tablets, three times per day.The aforesaid regimen gave total relief from both headache and epilepsy.

References1. Shevel EI (2016) A report of three patients in whom the surgical closure of terminal branches of the external carotid arteries for treatment of 2. Herial NA, Khan AA, Нompson M, Suri MF, Qureshi AI ( 2014) Flowdiversion headaches in a patient with high-grade internal carotid artery stenosis. J Vasc Interv Neurol 7: 9-11. 3. Wilner AN, Sharma BK, Нompson AR, Krueger A (2016) Analgesic opioid use in a health-insured epilepsy population during 2012. Epilepsy Behav 57(PtA): 126-132. 4. Derakhshan I (2016) Analgesic opioid use in a health-insured epilepsy population during 2012: Consider migralepsy. Epilepsy Behav 60: 238. 5. Wilner AN, Sharma BK, Нompson AR, Krueger A (2016) Analgesic opioid use in a health-insured epilepsy population during 2012: Response to Derakhshan. Epilepsy Behav 60: 239. 6. Verrotti A, Laino D, Rinaldi VE, Suppiej A, Giordano L, et al (2016) Clinical dissection of childhood occipital epilepsy of Gastaut and prognostic implication. Eur J Neurol 23: 241- 246. 7. Derakhshan I (2016) Hitting two birds with one stone: daily scheduled opioids in preventing migraine and migrainerelated epilepsy (migralepsy). Eur J Neurol 2016 23: e58. 8. Verrotti A, Tambucci R, Striano P (2016) Reply to ‘Hitting two birds with one stone: Daily scheduled opioids in preventing migraine and migrainerelated epilepsy (migralepsy)’. Eur J Neurol 23: e60-61. 9. Miller H (1968) Pain in the face. Br Med J 5605: 577-580. 10. Derakhshan I (2015) Нe diagnosis and treatment of chronic migraine: the case for daily scheduled opioid treatment in chronic headache. Нer Adv Chronic Dis 6: 389. 11. Hutchison R (2005) Opioids: Нe role in headache pharmacotherapy. J Opioid Manag 1: 193-194. 12. Finocchi C, Viani E (2013) Opioids can be useful in the treatment of headache. Neurol Sci 34 Suppl 1: S119-124. 13. Piekos K, Spierings EL (2009) Management of daily headache unresponsive to preventive treatment: Daily triptans versus daily opioids. Rev Neurol Dis 6: E121-130. 14. Ziegler DK (1997) Opioids in headache treatment. Is there a role? Neurol Clin 15: 199-207. 15. Sprenger T, Seifert CL, Miederer M, Valet M, Tölle TR (2008) Successful prophylactic treatment of chronic cluster headache with low-dose levomethadone. J Neurol 255: 1832-1833. 16. Bonezzi C, Demartini L (1999) Treatment options in postherpetic neuralgia. Acta Neurol Scand Suppl 173: 25- 35; discussion 48-52. 17. Spierings EL, Volkerts ER, Heitland I, Нompson H (2014) A randomized, rater-blinded, crossover study of the ejects of oxymorphone extended release, fed versus fasting, on cognitive performance as tested with CANTAB in opioidtolerant subjects. Pain Med 15: 264–271.

Citation:

Iraj Derakhshan. A Therapeutic Link Between Migraine and Epilepsy. World Neurosurgery Research 2024.