CORRESPONDENCE

Patients in whom surgical closure of terminal branches of external carotid arteries for migraine treatment resulted in reduced frequency of epileptic attacks

To the Editor: I read the recent case report by Shevel^[1] with regard to three cases of migralepsy with great interest. The author described postoperative improvement in migraine after surgical bilateral closure of terminal branches of external carotid arteries, which in every case was associated with marked reduction in occurrences of epilepsy in the same patients. I would like to point out that migralepsy (i.e. migraine-related epilepsy) is a common entity, affecting ~50% of people suffering from essential headaches (migraine and other nondescript headaches).^[2-5] The veracity of the author's finding is attested to by a similar dramatic improvement in migraine-related seizures after headaches are brought under adequate control, using daily scheduled maintenance therapy with opioids, employing dosetitrating methodology. This may require up-titrating the dose to very high levels in some patients.^[6]

Iraj Derakhshan

University of Cincinnati, Cincinnati, and Case Western Reserve University, Cleveland, OH, USA

idneuro@hotmail.com

REFERENCES

1. Shevel EI. A report of three patients in whom the surgical closure of terminal branches of the external carotid arteries for treatment of migraine resulted in significantly reduced frequency of epileptic attacks. S Afr Med J 2016;106(11):1084-1085. http://dx.doi.org/10.7196/SAMJ.2016.v106i11.10866        [ Links ]

2. Wilner AN, Sharma BK, Thompson AR, Krueger A. Analgesic opioid use in a health-insured epilepsy population during 2012. Epilepsy Behav 2016;57:126-132. http://dx.doi.org/10.1016/j.yebeh.2016.01.033        [ Links ]

3. Derakhshan I. Analgesic opioid use in a health-insured epilepsy population during 2012: Consider migralepsy. Epilepsy Behav 2016;60:238. http://dx.doi.org/10.1016/j.yebeh.2016.04.013        [ Links ]

4. Wilner AN, Sharma BK, Thompson AR, Krueger A. Analgesic opioid use in a health-insured epilepsy population during 2012: Response to Derakhshan. Epilepsy Behav 2016;60:239. http://dx.doi.org/10.1016/j.yebeh.2016.04.016        [ Links ]

5. Harnod T, Wang YC, Kao CH. High risk of developing subsequent epilepsy in young adults with migraine: A nationwide population-based cohort study in Taiwan. QJM 2015;108(6):449-455. http://dx.doi.org/10.1093/qjmed/hcu215        [ Links ]

6. Spierings EL, Volkerts ER, Heitland I, Thomson H. A randomized, rater-blinded, crossover study of the effects of oxymorphone extended release, fed versus fasting, on cognitive performance as tested with CANTAB in opioid-tolerant subjects. Pain Med 2014;15(2):264-271. http://dx.doi.org/10.1111/pme.12307        [ Links ]