Managing Epilepsy: Headaches and Menstrual Pain in Young Women

Headache, menstruation, epilepsy?

Hello Dr.
Huang, I am very touched by your patience and thoroughness in answering everyone's questions.
I am 22 years old and had a seizure in my sleep when I was 15, after which I started medication without any side effects.
Initially, I was taking four extended-release Tegretol (200 mg) daily, but I have now reduced it to two pills a day, one in the morning and one in the evening, and my condition has been well controlled.
My experience is that I only have seizures during sleep, and I can sense the situation before waking up; however, I have not had any seizures in the past two years.
My EEG has always shown normal results while awake.
After my EEG showed normal results, I attempted to reduce my medication by half a pill, but I became apprehensive about discontinuing it after I sensed the pre-seizure situation in my sleep.

Doctor, should I undergo a sleep EEG for a more accurate assessment? Is it possible for me to further reduce or discontinue my medication? What is the safest way to proceed with this? Recently, I have experienced several instances of headaches and tightness in my scalp during my menstrual period, in addition to abdominal pain.
I would like to ask if this could be related to my medication, or is it simply due to academic pressure combined with my menstrual cycle? Thank you for patiently reading my questions.

mimi, 20~29 year old female. Ask Date: 2005/07/15

Dr. Huang Yingzhe reply Neurology

Dear Dr.
Huang Ying-Che, Director of the Neurology Department at Tainan Hospital, Department of Health, Executive Yuan:
1.
It is certainly advisable to conduct a sleep EEG.
2.
Generally speaking, if there have been no seizures for 2 to 3 years and the follow-up EEG is normal, consideration can be given to discontinuing medication; however, this decision must still be based on individual circumstances and conditions.
3.
It is possible that stress may be a contributing factor, but a detailed history, examination, and possibly further testing and observation are necessary to determine this more definitively.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2005/07/15

More Info

Managing epilepsy, particularly in young women, can be complex due to the interplay of hormonal changes, medication effects, and lifestyle factors. Your experience with epilepsy and the management of your condition through medication is commendable, especially considering the challenges that can arise during the menstrual cycle.

Firstly, regarding your epilepsy management, it is crucial to consult with a neurologist or an epileptologist before making any changes to your medication regimen. Tegretol (carbamazepine) is a commonly prescribed antiepileptic drug that can be effective in controlling seizures. However, the decision to reduce or discontinue medication should be made cautiously and under medical supervision. A sleep EEG (electroencephalogram) could provide valuable insights into your brain activity during sleep, especially since your seizures have occurred during this time. This test can help determine if there are any abnormal brain wave patterns that could indicate a risk of seizure recurrence.

As for your menstrual cycle, it is well-documented that hormonal fluctuations can influence seizure activity in some women. The premenstrual phase, characterized by a drop in estrogen and progesterone, can lead to increased seizure frequency for some individuals. Additionally, the physical symptoms of menstruation, such as abdominal cramps and headaches, can exacerbate stress and tension, potentially leading to a heightened perception of pain or discomfort. The headaches you are experiencing during your menstrual period could be tension-type headaches or even menstrual migraines, which are common in women with hormonal fluctuations.

To address your headaches and menstrual pain, consider the following strategies:
1. Pain Management: Over-the-counter pain relievers such as ibuprofen or naproxen can be effective for menstrual cramps and associated headaches. However, consult your healthcare provider to ensure these medications do not interact with your epilepsy medication.

2. Lifestyle Modifications: Regular exercise, adequate hydration, and a balanced diet can help alleviate some menstrual symptoms. Stress management techniques, such as yoga, meditation, or deep-breathing exercises, can also be beneficial.

3. Hormonal Treatments: If your headaches are significantly impacting your quality of life, discuss with your healthcare provider the possibility of hormonal treatments, such as birth control pills, which can help regulate hormonal fluctuations and potentially reduce headache frequency.

4. Monitoring Symptoms: Keep a headache diary to track the frequency, duration, and intensity of your headaches, as well as any associated symptoms. This information can be valuable for your healthcare provider in determining the best course of action.

5. Regular Follow-ups: Maintain regular appointments with your neurologist to monitor your epilepsy and discuss any changes in your symptoms or medication. This is particularly important if you are considering reducing your medication.

In conclusion, while your epilepsy appears to be well-managed, the headaches and menstrual pain you are experiencing warrant further investigation. It is essential to approach any changes to your medication or treatment plan with caution and under the guidance of a healthcare professional. By addressing both your epilepsy and menstrual symptoms holistically, you can work towards achieving a better quality of life. Always prioritize open communication with your healthcare team to ensure that all aspects of your health are considered in your treatment plan.

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