Epilepsy: Symptoms, Diagnosis, Investigations, and Treatment Options
Epilepsy is a common neurological condition that causes a person to have recurrent, unprovoked seizures. It affects people of all ages and can present in many different ways. With accurate diagnosis and appropriate treatment, the majority of people with epilepsy achieve good seizure control and maintain a good quality of life.
This page outlines the common symptoms of epilepsy, how epilepsy is diagnosed, which investigations are used, and the treatments available.
Symptoms of Epilepsy
Epilepsy symptoms vary depending on the area of the brain involved. Not all seizures involve loss of consciousness or convulsions.
Common epilepsy symptoms include:
- Sudden loss of awareness or responsiveness
- Brief staring episodes or behavioural arrest
- Involuntary movements, such as jerking of the arms or legs
- Sudden collapse or loss of muscle tone
- Sensory symptoms, including unusual smells, tastes, visual changes, or tingling
- A rising sensation in the stomach, fear, or déjà vu
- Confusion, headache, or fatigue after an episode
Some seizures can be subtle and may be mistaken for fainting, panic attacks, or non-epileptic events. A careful medical history is therefore essential.
How Is Epilepsy Diagnosed?
The diagnosis of epilepsy is primarily clinical, based on a detailed description of the events. There is no single test that can diagnose epilepsy on its own.
Assessment typically includes:
- A detailed neurological consultation
- Description of events from the patient and, where possible, witnesses
- Review of medical history, medications, and risk factors
- Classification of seizure type
The aim is to determine whether the events represent epileptic seizures and, if so, to identify the seizure type and possible cause.
Investigations for Epilepsy
Investigations are used to support the diagnosis and guide management. These may include:
MRI Brain
- Used to assess for structural causes of epilepsy
- Particularly important after a first seizure or in focal epilepsy
EEG (Electroencephalogram)
- Records electrical activity in the brain
- Can help support the diagnosis and classify seizure type
- A normal EEG does not exclude epilepsy
CT Brain
- Used in certain acute settings
- Not a substitute for MRI in epilepsy assessment
Blood Tests
- Performed where appropriate to exclude metabolic or systemic causes
Investigations are interpreted alongside the clinical history rather than in isolation.
Treatment Options for Epilepsy
Treatment is individualised and depends on seizure type, epilepsy syndrome, age, lifestyle, and patient preference.
Anti-Seizure Medications
- First-line treatment for most people with epilepsy
- Many patients achieve good seizure control with a single medication
- Treatment is tailored to minimise side effects
Ongoing Review
- Regular follow-up to assess seizure control and tolerability
- Adjustments made if seizures continue or side effects occur
Specialist Management
- Considered if seizures are difficult to control
- May include further investigations or referral to specialist services
Lifestyle factors such as sleep, alcohol intake, and seizure triggers are also addressed as part of comprehensive care.
Living with Epilepsy
A diagnosis of epilepsy can feel overwhelming, particularly following a first seizure. Clear explanation, appropriate investigation, and a structured management plan are essential.
With specialist neurological care, most individuals with epilepsy are able to understand their condition, manage risks, and lead full and active lives.
When to See an Epilepsy Specialist
Specialist assessment is recommended for:
- A first suspected seizure
- Recurrent unexplained blackouts or episodes
- Diagnostic uncertainty
- Poor seizure control or medication side effects
- Requests for a second opinion
This information is intended as general guidance and does not replace individual medical advice.
Headaches: Causes, Diagnosis, and Treatment Options Including Migraine as the Most Common Cause
Headache is one of the most common neurological symptoms and a frequent reason for referral to a neurologist. While most headaches are not due to serious underlying disease, accurate diagnosis is essential to guide effective treatment and to identify cases that require further investigation.
This page outlines the common causes of headache, how headaches are diagnosed, important differential diagnoses, and the treatment options available, with a particular focus on migraine, the most common cause of recurrent headache.
Common Causes of Headache
Headaches are broadly divided into primary and secondary headache disorders
.
Primary Headache Disorders
These are headaches not caused by another medical condition and include:
- Migraine (with or without aura)
- Tension-type headache
- Cluster headache and other trigeminal autonomic cephalalgias
Primary headaches account for the majority of cases seen in clinical practice.
Secondary Headache Disorders
Secondary headaches result from an underlying condition and may include:
- Headache related to infection or inflammation
- Headache following head injury or concussion
- Headache due to raised or low intracranial pressure
- Medication overuse headache
- Headache associated with vascular conditions
Identifying secondary causes is an important part of neurological assessment.
Migraine: The Most Common Cause of Recurrent Headache
Migraine is a common neurological condition characterised by recurrent headache attacks, often associated with other neurological symptoms.
Symptoms of Migraine
Migraine symptoms may include:
- Moderate to severe headache, often one-sided
- Throbbing or pulsating pain
- Sensitivity to light, sound, or smell
- Nausea and/or vomiting
- Worsening with physical activity
Some individuals experience migraine aura, which may include visual disturbance, sensory symptoms, or speech difficulty, usually preceding the headache.
Differential Diagnosis of Headache
A careful clinical history is essential to distinguish migraine from other headache disorders and to exclude secondary causes.
Key differential diagnoses include:
- Tension-type headache – typically mild to moderate, bilateral, and pressure-like
- Cluster headache – severe unilateral pain with autonomic features (tearing, nasal congestion)
- Medication overuse headache – daily or near-daily headache related to frequent painkiller use
- Post-traumatic headache – following head injury or concussion
- Raised intracranial pressure – headache worse on waking or with coughing
- Low cerebrospinal fluid pressure headache – worse on standing, relieved by lying down
- Secondary vascular causes, including less common conditions
Neurological assessment helps determine whether further investigation is required.
Diagnosis of Headache Disorders
The diagnosis of headache is primarily clinical, based on a detailed description of symptoms and headache pattern.
Assessment typically includes:
- A comprehensive neurological consultation
- Review of headache frequency, duration, triggers, and associated symptoms
- Medication history and response to treatments
- Identification of red flag symptoms
Brain imaging is not required for all patients but may be recommended where features suggest a secondary cause.
Investigations
Where appropriate, investigations may include:
- MRI brain to exclude structural or secondary causes
- CT brain in acute or emergency settings
- Blood tests if systemic causes are suspected
Normal imaging does not exclude migraine or other primary headache disorders.
Treatment Options for Migraine and Headache
Treatment is individualised and depends on headache type, frequency, severity, and patient preference.
Acute Migraine Treatment
Used to treat attacks when they occur and may include:
- Simple analgesics
- Triptans
- Anti-emetic medications
Early treatment is often more effective.
Preventative Migraine Treatment
Considered when migraines are frequent or disabling. Options may include:
- Oral preventative medications
- Lifestyle modification, including sleep and trigger management
- Adjustment of acute medication to avoid medication overuse headache
Preventative treatment aims to reduce headache frequency, severity, and impact on daily life.
Living with Migraine and Chronic Headache
Migraine and other headache disorders can have a significant impact on quality of life. Clear diagnosis, appropriate treatment selection, and regular review are essential.
With specialist care, many patients experience significant improvement in symptoms and are able to regain control over their condition.
When to See a Neurologist for Headache
Neurological assessment is recommended if:
- Headaches are new, worsening, or changing in pattern
- There is diagnostic uncertainty
- Headaches are frequent or disabling
- Treatment is ineffective or poorly tolerated
- There are neurological symptoms or red flag features
This information is intended as general guidance and does not replace individual medical advice.
Migraine: Symptoms, Diagnosis, and Treatment Options
Migraine is a common neurological condition and one of the leading causes of recurrent headache. It affects people of all ages and can have a significant impact on daily life. With accurate diagnosis and appropriate treatment, most individuals with migraine experience good symptom control.
This page outlines the symptoms of migraine, how migraine is diagnosed, and the treatment options available.
What Is Migraine?
Migraine is a neurological disorder characterised by recurrent headache attacks, often associated with other symptoms such as nausea and sensitivity to light or sound. It is not simply a headache and involves changes in brain signalling and sensory processing.
Symptoms of Migraine
Migraine symptoms vary between individuals and between attacks. Common features include:
- Moderate to severe headache, often one-sided
- Throbbing or pulsating pain
- Sensitivity to light (photophobia) and sound (phonophobia)
- Nausea and vomiting
- Worsening with physical activity
Some people experience migraine aura, which may include:
- Visual disturbance (flashing lights, zigzag lines, blind spots)
- Sensory symptoms such as tingling or numbness
- Speech or language disturbance
Aura symptoms are usually temporary and precede the headache.
Diagnosis of Migraine
The diagnosis of migraine is clinical, based on a detailed description of symptoms and headache pattern. There is no single test that confirms migraine.
Assessment includes:
- Review of headache frequency, duration, and triggers
- Associated symptoms and response to medication
- Neurological examination
Brain imaging is not required for most people with typical migraine but may be recommended if there are atypical features or red flag symptoms.
Treatment Options for Migraine
Treatment is tailored to the individual and depends on headache frequency, severity, and impact on daily life.
Acute Migraine Treatment
Used to treat migraine attacks when they occur and may include:
- Simple analgesics
- Triptans
- Anti-emetic medication
Early treatment is often more effective.
Preventative Migraine Treatment
Considered when migraines are frequent or disabling. Options may include:
- Oral preventative medications
- Lifestyle and trigger management
- Review of acute medication use to avoid medication overuse headache
The aim of preventative treatment is to reduce migraine frequency, severity, and duration.
Living with Migraine
Migraine can be unpredictable and disruptive, but many people achieve good control with appropriate treatment. Clear explanation of the diagnosis and a structured management plan are central to effective care.
When to See a Neurologist
Specialist assessment may be helpful if:
- Migraine attacks are frequent or severe
- Headaches are changing in pattern
- Treatment is ineffective or poorly tolerated
- There is diagnostic uncertainty
This information is intended as general guidance and does not replace individual medical advice.
Dizziness and Balance Problems: Causes, Diagnosis, and Treatment
Dizziness and balance problems are common symptoms and a frequent reason for referral to a neurologist. The term “dizziness” is often used to describe a range of sensations, including spinning, lightheadedness, unsteadiness, or a feeling of imbalance. Careful assessment is essential to identify the underlying cause and guide appropriate treatment.
This page outlines the common causes of dizziness, important differential diagnoses, how dizziness is investigated, and the treatment options available.
Types of Dizziness
Understanding the nature of the dizziness is the first step in diagnosis. Common descriptions include:
- Vertigo – a sensation that the room or the individual is spinning
- Lightheadedness – a feeling of faintness or “about to pass out”
- Imbalance or unsteadiness – difficulty walking straight or feeling unstable
- Non-specific dizziness – vague or difficult-to-describe symptoms
Each points toward different potential causes.
Common Causes of Dizziness and Balance Problems
Vestibular (Inner Ear) Causes
These are among the most common causes of vertigo and include:
- Benign paroxysmal positional vertigo (BPPV)
- Vestibular neuritis or labyrinthitis
- Ménière’s disease
These conditions often cause true vertigo and may be associated with nausea or imbalance.
Neurological Causes
Neurological conditions that may cause dizziness or balance problems include:
- Migraine-associated dizziness
- Stroke or transient ischaemic attack (less common, but important to exclude)
- Multiple sclerosis
- Disorders affecting balance pathways in the brain
Cardiovascular and Systemic Causes
Some causes are not primarily neurological but may present with dizziness:
- Postural (orthostatic) hypotension
- Cardiac rhythm disturbances
- Dehydration or medication side effects
Functional and Non-Structural Causes
In some individuals, dizziness occurs without an identifiable structural cause and may be related to:
- Functional neurological disorder (FND)
- Persistent postural-perceptual dizziness (PPPD)
- Anxiety-related or stress-related symptoms
These diagnoses are clinical and require careful explanation and reassurance.
Differential Diagnosis of Dizziness
Key conditions considered during assessment include:
- Benign positional vertigo
- Vestibular migraine
- Postural hypotension
- Cerebrovascular causes
- Medication-related dizziness
- Functional dizziness
A detailed history and examination are crucial to distinguish between these possibilities.
Diagnosis and Assessment
The diagnosis of dizziness is primarily clinical. A neurological consultation focuses on:
- Description of symptoms and triggers
- Duration and frequency of episodes
- Associated symptoms such as headache, hearing changes, or neurological deficits
- Medical history and medication review
Examination may include assessment of eye movements, balance, coordination, and gait.
Investigations
Investigations are tailored to the individual and may include:
- MRI brain to exclude structural or neurological causes
- CT brain in acute or emergency settings
- Blood tests if systemic causes are suspected
- Vestibular testing where appropriate
Many patients with dizziness have normal imaging, which is often reassuring.
Treatment Options
Treatment depends on the underlying cause and may include:
Vestibular Treatments
- Repositioning manoeuvres for BPPV
- Vestibular rehabilitation exercises
Migraine-Related Dizziness
- Migraine-specific treatment
- Lifestyle and trigger management
Medical and Supportive Management
- Review and adjustment of medications
- Management of blood pressure or hydration
- Advice regarding activity and balance confidence
Functional Dizziness
- Clear explanation and reassurance
- Multidisciplinary management where appropriate
Living with Dizziness and Balance Problems
Dizziness can be distressing and impact daily activities, work, and confidence. With accurate diagnosis and appropriate management, many patients experience significant improvement in symptoms.
Clear explanation of the diagnosis and a structured treatment plan are central to recovery.
When to See a Neurologist
Neurological assessment is recommended if:
- Dizziness is persistent or worsening
- There is diagnostic uncertainty
- There are associated neurological symptoms
- Balance problems are affecting mobility or safety
- Initial treatments have been ineffective
This information is intended as general guidance and does not replace individual medical advice.
Post-Concussion and Mild Traumatic Brain Injury (mTBI)
A mild traumatic brain injury (mTBI), often referred to as a concussion, is a common neurological injury that may occur following a blow to the head, a fall, or rapid acceleration or deceleration of the head and neck. Most people recover fully, but some experience persistent symptoms that require specialist assessment.
This page outlines post-concussion symptoms, how mTBI is diagnosed, and the treatment options available.
What Is a Mild Traumatic Brain Injury?
A mild traumatic brain injury occurs when the brain is temporarily affected by trauma. Loss of consciousness may occur but is not required for a diagnosis of concussion.
Imaging such as CT or MRI is often normal in mTBI and does not exclude the diagnosis.
Symptoms of Post-Concussion Syndrome
Symptoms usually develop immediately or within days of the injury and may include:
- Headache or pressure in the head
- Dizziness or balance problems
- Fatigue
- Difficulty concentrating or memory problems
- Sensitivity to light or noise
- Sleep disturbance
- Irritability, anxiety, or low mood
For most individuals, symptoms improve within weeks to a few months. A smaller proportion experience more prolonged symptoms, known as post-concussion syndrome.
Diagnosis of Post-Concussion Symptoms
The diagnosis of mTBI and post-concussion symptoms is clinical, based on:
- The mechanism of injury
- Symptom pattern and progression
- Neurological assessment
- Review of previous imaging and medical history
Brain imaging is not always required but may be recommended if symptoms are atypical, worsening, or associated with neurological signs.
Differential Diagnosis
Symptoms following head injury may overlap with other conditions, including:
- Migraine or post-traumatic headache
- Vestibular disorders causing dizziness
- Cervical (neck-related) symptoms
- Functional neurological symptoms
- Anxiety or sleep disturbance
Careful assessment helps identify contributing factors and guide management.
Treatment and Management
There is no single treatment for post-concussion symptoms. Management is individualised and may include:
- Education and reassurance regarding prognosis
- Gradual return to physical and cognitive activity
- Headache and migraine management
- Treatment of dizziness or balance symptoms
- Addressing sleep, mood, and anxiety where relevant
Avoidance of prolonged complete rest is generally recommended, with a structured, graded return to activity.
Prognosis
Most people with mild traumatic brain injury make a full recovery. Early explanation, appropriate guidance, and tailored management are key factors in symptom resolution and recovery.
When to Seek Specialist Advice
Neurological assessment is recommended if:
- Symptoms persist beyond several weeks
- Headaches or dizziness are worsening
- There is difficulty returning to work or daily activities
- There is diagnostic uncertainty or concern about recovery
This information is intended as general guidance and does not replace individual medical advice.