Headache as an epileptic manifestation

Abstract

In two cases, depth electrode studies and behavioral recordings indicated that headache was a clinical manifestation of ictal activity. The epileptogenic focus was found in the right limbic system, and right temporal lobectomy relieved the headaches.

Post-epileptic headache and migraine.

“…Although in this series of 51 patients with post-epileptic headaches all these four cardinal features were only present in three cases, 8 patients showed three of the four features, 17 suffered two, 11 only one and eight patients had none of these features. This does not, in the authors' opinion, detract from the similarity between these two conditions.…”

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

“…Intravenous administration of AEDs in these patients was able to control the seizure, as demonstrated by means of a scalp EEG as well as resolution of the headache symptoms (Parisi et al 2012a, b). However, some isolated cases of "ictal epileptic headache" reported in the literature were incidentally detected when the critical focus was being recorded by means of deep electrodes (Laplante et al 1983;Fusco et al 2011). Therefore, although the EEG recording may not prove very useful as a screening instrument for migraine, it does play a fundamental role in pediatric patients who have headache/migraine symptoms that do not respond to commonly-used anti-migraine drugs (Parisi et al 2012a, b).…”

“…In such cases, ictal epileptic EEG activity might be recorded as unspecific slow wave abnormalities without any spike activity (Belcastro et al 2011a;Parisi et al 2012b). Interestingly, there may, on rare occasions, be an isolated epileptic headache that has no associated ictal epileptic manifestations or scalp EEG abnormalities but whose ictal epileptic origin can be demonstrated by depth electrode studies, even purely by chance (Laplante et al 1983;Fusco et al 2011).…”

“…mainly a peri-ictal phenomenon), but in some cases (whose number is probably largely underestimated) "the headache represents the only ictal phenomenon": we recently named this condition "ictal epileptic headache" (Parisi et al 2012a). Since 1971, fewer than 20 IEH cases diagnosed according to proposed criteria (Table 1, Parisi et al 2012b) have been reported (Grossman et al 1971;Walser and Isler 1982;Laplante et al 1983;Isler et al 1987;Niedermeyer 1993;Marks and Ehrenberg 1993;Walker et al 1995;Ghofrani et al 2006;Parisi et al 2007;Piccioli et al 2009;Perucca et al 2010;Belcastro et al 2011c;Fusco et al 2011;Italiano et al 2011;Fanella et al 2012;Cianchetti et al 2013). Verrotti et al recently published 16 other potential ictal epileptic headache cases from a large multicentre neuropediatric sample (Verrotti et al 2011b), stressing the concept of "probable underestimate phenomenon" (Parisi et al 2012a;Parisi et al 2013a, b).…”

“…Following the introduction of the migralepsy concept by Lennox and Lennox (1960), an increasing number of ictal epileptic headaches have been reported since the 1970s (Grossman et al 1971;Walser and Isler 1982;Laplante et al 1983;Isler et al 1987;Niedermeyer 1993;Marks and Ehrenberg 1993;Walker et al 1995;Ghofrani et al 2006;Parisi et al 2007;Piccioli et al 2009;Perucca et al 2010;Belcastro et al 2011c;Fusco et al 2011;Italiano et al 2011;Fanella et al 2012;Cianchetti et al 2013). It has also been suggested (Parisi and Kasteleijn-Nolst Trenité 2010;Belcastro et al 2011a;Verrotti et al 2011a, b;Striano et al 2011Striano et al , 2012Parisi et al 2012aParisi et al , 2013a that the migralepsy sequence may not exist at all and that the initial part of the "migralepsy sequence" may merely be an "ictal epileptic headache" (Parisi et al 2012a) followed by other ictal autonomic, sensory, motor or psychic features.…”