Headaches add to the burden of epilepsy

Abstract

The objective was to investigate and classify headaches in 109 consecutive adult patients with epilepsy. A semi-structured interview was performed in those who confirmed such symptoms (65%). Interictal headaches were present in 52%; 20% had interictal migraine. Postictal headache was reported in 44%. Migraine characteristics were present in 42% of these, and most of them (74%) also suffered from interictal migraine. Six percent had preictal headache. In partial epilepsy, there was an association between headache lateralisation and interictal EEG abnormalities (p=0.02). We conclude that headache, including migraine, is very common in patients with epilepsy. Unilateral headache may represent a lateralising sign in focal epilepsy. Seizures often trigger postictal headaches with migraine features, which often are associated with interictal migraine. Migrainous headaches sometimes proceed into epileptic seizures. The comorbidity of migraine and epilepsy should receive ample clinical attention, as it may influence antiepileptic drug choice, and the headache may need specific treatment.

Headache among mesial temporal lobe epilepsy patients: A case-control study

“…Syvertsen et al reported a 65% prevalence of headache in a general epileptic population [25]. Yankovsky et al investigated one hundred patients who were undergoing presurgical evaluation for pharmacologically intractable partial epilepsy, and recurrent headache was reported by 59% of the patients [5].…”

Secondary intracranial causes for headaches in children

“…A study of adults with epilepsy determined 65% had comorbid migraines when queried [ 3 ]. A similar study has not been performed in children.…”

“…Most retrospective studies conducted reported very low rates of ictal headaches, even during simple partial epileptic seizures [ 3 ]. There have been reports of adults describing throbbing, sharp, or steady pain during partial seizures, but this is less commonly reported in the pediatric population [ 5 ].…”

Postictal headache in epileptic patients

“…HELP Study Group studies [5] have reported the association between younger age and seizure-related headaches (86% of them had PIH). Syvertsen et al reported the association between younger age and headaches (68% had PIH) [10] .…”

“…Several other studies have reported the use of analgesics by patients with PIH. Most patients used over-the-counter analgesics, such as aspirin, and acetaminophen, and only 4% and 11% in another were prescribed anti-headache medications by their physicians [10,37] . However, a relatively small percentage of people with PIH are taking analgesics or being prescribed medications by their physicians, which probably reflects the neglected status of the PIH entity within the medical community.…”