In this case–control study, we retrospectively reviewed electronic medical records (Montefiore Epic) of adults (≥18 years) diagnosed with epilepsy, with or without migraine per ICD-10 codes. Patients with only psychogenic nonepileptic seizures (PNES), provoked seizures, or other headache diagnoses were excluded. Seizure control was assessed via antiseizure medication (ASM) use, seizure frequency, epilepsy surgery referrals, presence of RNS or VNS, and EMU admissions. Migraine severity was evaluated through triptan prescriptions and headache center referrals. Data were analyzed using logistic regression.

Of 200 patients, 55% had epilepsy and 45% had both migraine and epilepsy. 68.5% of patients were female and 31.5% male. The median age of epilepsy diagnosis was 18 years old. Seizure control was poor in 36% of patients (last seizure within the past year) and well-controlled in 64% (last seizure over a year ago). Significant differences were identified in the migraine and epilepsy group including decreased seizure frequency (p < .028), increased depression and anxiety (p < .004), and greater number of female patients (p < .001) compared to the epilepsy only group.  Factors associated with better seizure control included triptan prescription, later age of epilepsy diagnosis, and older age. 

This study suggests migraine treatment may have a role in improving seizure control in patients with both conditions. Patients with migraine and epilepsy may benefit from regular screening for depression and anxiety. Lastly, female epilepsy patients should be regularly screened for migraine.