Aspirin and Epilepsy: Is It Safe to Take Aspirin If You Have Seizures?

People with epilepsy often wonder if common painkillers like aspirin are safe to take. After all, you don’t want to risk triggering a seizure just to ease a headache. The good news? Aspirin itself doesn’t cause seizures. But there’s more to the story than just yes or no.

Aspirin doesn’t trigger seizures

Unlike some other medications-like certain antidepressants or stimulants-there’s no solid evidence that aspirin lowers the seizure threshold. That means it doesn’t make your brain more likely to have a seizure. Studies dating back to the 1990s, including those published in Epilepsia and the Journal of Neurology, Neurosurgery & Psychiatry, found no link between standard doses of aspirin and increased seizure activity in people with epilepsy.

One reason? Aspirin works by blocking enzymes involved in inflammation and pain, not by affecting brain electrical activity. It doesn’t interfere with how neurons fire or how neurotransmitters like GABA and glutamate behave. That’s different from drugs like tramadol or bupropion, which have known seizure risks.

What about interactions with anti-seizure drugs?

This is where things get tricky. Aspirin can interact with some anti-epileptic medications, especially valproate and phenytoin. With valproate, aspirin may increase its levels in your blood. That sounds helpful, but too much valproate can cause drowsiness, tremors, or even liver problems. In rare cases, it might push someone closer to toxicity.

With phenytoin, aspirin can slightly reduce how well the drug works. That’s because aspirin competes for protein binding sites in the blood. If phenytoin levels drop too low, seizure control could weaken. This isn’t common, but it’s been documented in case reports-especially when people take high-dose aspirin regularly (like 650 mg or more, several times a week).

Most people taking low-dose aspirin (75-100 mg daily) for heart health don’t see these effects. But if you’re on a higher dose for arthritis or chronic pain, talk to your neurologist. Blood tests can check your medication levels and catch any changes early.

When aspirin might be risky

There are two situations where aspirin isn’t just risky-it’s dangerous.

First, if you have Reye’s syndrome risk factors. This rare but deadly condition affects the liver and brain and is linked to aspirin use in children and teens with viral infections. While it’s extremely rare in adults, some neurologists still avoid recommending aspirin for anyone under 18 with epilepsy, just to be safe.

Second, if you have a history of gastrointestinal bleeding or ulcers. Aspirin thins the blood and irritates the stomach lining. People with epilepsy are more likely to fall or have injuries during seizures, which increases bleeding risk. If you’ve ever had a bleed in your stomach or intestines, aspirin could make things worse.

Alternatives to aspirin for pain relief

If you’re worried about interactions or side effects, there are safer options.

• Paracetamol (acetaminophen) is usually the first choice. It doesn’t interact with anti-seizure drugs and has a low risk of triggering seizures.
• Ibuprofen is also generally safe, though it can slightly lower the seizure threshold in very high doses or in people with kidney problems. Stick to the lowest effective dose.
• Topical pain relievers like menthol creams or lidocaine patches can help with muscle aches without affecting your brain at all.

Don’t assume all OTC painkillers are equal. Some cold and flu medicines contain pseudoephedrine or dextromethorphan-both can lower seizure thresholds. Always check the label.

What the guidelines say

The International League Against Epilepsy (ILAE) doesn’t list aspirin as a medication to avoid. Their 2023 update on drug safety in epilepsy says: "Common analgesics, including aspirin and paracetamol, are considered safe for most patients with epilepsy when used appropriately."

The American Epilepsy Society echoes this. Their clinical guidance recommends that patients with epilepsy can use aspirin for short-term pain relief, provided they don’t have contraindications like bleeding disorders, kidney disease, or are on high-dose valproate.

The key phrase here is "used appropriately." That means:

• Stick to the lowest dose needed
• Avoid long-term daily use unless prescribed
• Don’t mix with alcohol
• Stop if you get stomach pain, black stools, or dizziness

Real-life scenarios

Sarah, 42, has had focal seizures for 15 years. She takes lamotrigine and occasionally gets migraines. She used to take aspirin for them, but after her neurologist checked her blood levels, they found her lamotrigine was slightly higher than normal. She switched to paracetamol and hasn’t had a problem since.

David, 68, takes low-dose aspirin (75 mg) every day after a heart attack. He also has generalized tonic-clonic seizures controlled by levetiracetam. His neurologist reviewed his meds and confirmed no interaction. He keeps taking aspirin, and his seizures haven’t changed.

These stories show it’s not one-size-fits-all. Your seizure type, medications, age, and other health issues all matter.

When to call your doctor

You don’t need to panic if you took aspirin once. But call your neurologist if:

• You’ve been taking aspirin daily for more than a week
• You’ve noticed more seizures or different seizure patterns
• You feel unusually tired, nauseous, or confused
• You’re on valproate and started aspirin recently

These aren’t emergencies-but they’re signals to get checked.

Bottom line

Aspirin is generally safe for people with epilepsy, as long as you’re not on high-dose valproate, don’t have bleeding risks, and aren’t taking it long-term. For most, paracetamol is still the safest bet for regular pain relief. But if you need aspirin for heart protection or arthritis, you don’t have to give it up-just talk to your doctor first.

The goal isn’t to avoid all medications. It’s to use the right ones, at the right dose, with the right awareness. Your epilepsy doesn’t mean you can’t manage a headache. It just means you need to be a little more careful about how you do it.