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Is There A Medication That Can Be Prescribed For Treating Ongoing Migraine In Epileptic Patients

Posted on Fri, 7 Jul 2023

Question: Is there a medication that can be prescribed for treating an ongoing migraine in epileptic patients? To clarify, I am referring to a singular migraine episode, and I am inquiring about medications that are immediate treatment options rather than medications that require titration such as valproate or topiramate. The patient has a history of diagnosed migraines and is currently on lamotrigine and gabapentin to treat the epilepsy. Thank you for your assistance.

Answered by Dr. Neeraj Kumar (21 minutes later)

Brief Answer:
Get evaluated by a neurologist and take treatment as advised

Detailed Answer:

Hello,

For acute attacks, pain killers like naproxen, aceclofenac, paracetamol may be beneficial.
Drugs like rizatriptan, nazitriptan, sumatriptan can also be used in migraine attacks.

Hope you found the answer helpful. Do get back to me for further information.
Regards,
Dr. N. Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Neeraj Kumar (39 minutes later)

I understand sumatriptan and rizatriptan can lower the seizure threshold. I’m assuming a quick fingered typo intended to name naratriptan as the third option. Do any of these medications have a greater risk of lowering the seizure threshold in an epileptic patient effectively managing the condition using only gabapentin and lamotrigine at lower doses? Is there a lesser of three evils?

Answered by Dr. Neeraj Kumar (2 hours later)

Brief Answer:
Use pain killers instead of triptan first to abort acute migraine attacks

Detailed Answer:

Hello,

In epilepsy, use of any triptan decreases the seizure threshold and so pain killers are preferred first line medications.
Safest triptan can be Almotriptan > Zolmitriptan >sumatriptan>Naratriptan> Rizatriptan.
No triptan has zero risk of seizure.
Better to use pain killers as mentioned earlier.

Regards,
Dr. N. Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj