Headache in epilepsy: A prospective observational study

Abstract

ObjectiveTo assess the frequency and characteristics of interictal and postictal headaches (using International Classification of Headache Disorders, 3rd edition criteria) in a population of patients with epilepsy admitted to the Mayo Clinic Rochester epilepsy monitoring unit and assess their localizing value.MethodsThis was a cross‐sectional study. Participants were voluntarily recruited upon admission to the epilepsy monitoring unit. Two separate questionnaires were then administered. The first was to assess the presence and character of headaches experienced in the past 12 months. The second was to assess characteristics of postictal headaches experienced during their admission including localization.ResultsOne‐hundred and twenty subjects (77%) met inclusion criteria and completed the initial questionnaire. Mean age was 38.1 years (range 18‐82), and 67 (55.8%) were female. Interictal headaches were reported in 97 of 120 (81%) subjects, and these met ICHD3 criteria for migraine in 48 (50%). Postictal headaches were reported by 75 of 120 (63%) subjects on the initial admission questionnaire, representing migraine in 38 (51%). Thirty‐nine (32%) subjects completed the secondary questionnaire related to postictal headaches experienced during admission, of which nine (23%) met criteria for migraine. There was no seizure lateralizing or localizing value noted based on postictal headache localization.SignificanceMigraine was frequent in this cohort and appears to be the dominant interictal and postictal headache type in patients with epilepsy. In this study, the first to assess incident postictal headache in the setting of an ictal EEG, headache localization was of no seizure localizing value. Few patients were being actively treated; suggesting headache management is often overlooked in the epilepsy population.

Headache in people with epilepsy

“…A more recent meta-analysis (including studies published between 2004 and 2019) estimated a 49% prevalence of unspecified headache among people with epilepsy 9 . Additional evidence has confirmed the findings of these meta-analyses regarding the co-existence of epilepsy and headache (Table 1) [10][11][12][13][14][15][16][17][18][19] . In these studies, ≤79% of individuals with epilepsy reported experiencing headaches.…”

“…Women with epilepsy tended to report migraine more often than men with epilepsy 11,12,16,18,20 . No clear relationship between headache type and epileptic focus location, seizure type, seizure frequency, or use of antiseizure medication was identified in these recent studies 13,16 .…”

“…Women with epilepsy tended to report migraine more often than men with epilepsy 11,12,16,18,20 . No clear relationship between headache type and epileptic focus location, seizure type, seizure frequency, or use of antiseizure medication was identified in these recent studies 13,16 . One older study reported that peri-ictal headaches were ipsilateral to the epileptic focus in temporal epilepsy, but not in extra-temporal epilepsy 22 .…”

“…In these studies, ≤79% of individuals with epilepsy reported experiencing headaches. The most common headache types in individuals with epilepsy were migraine (reported by ≤25% of participants) and TTH (reported by ≤40% of participants) 10,13,14,16,18 .…”

“…Post-ictal headache is defined as a headache caused by an epileptic seizure, occurring < 3 hours after the end of the seizure event and remitting spontaneously < 72 hours after seizure termination 5 . Evidence indicates that postictal headache occurs in < 45% of individuals with epilepsy (Table 1), making it the most common type of periictal headache [10][11][12][13][14][15][16][17]19,21 . In ~ 50% of individuals with post-ictal headache, the headache is migraine-like (Table 1) [10][11][12][14][15][16][17] .…”