Pure epileptic headache and related manifestations: a video‐EEG report and discussion of terminology

Abstract

We present the first video‐EEG recording of episodes of “epileptic headache”. The case reported is that of a 9‐year‐old girl with brief episodes (of a few minutes) of severe frontal headache, which corresponded to the presence of concurrent spikes and slow waves, starting in the right temporal area. A dysplastic lesion of the right temporal lobe was observed by MRI and the patient received surgery, with subsequent disappearance of headaches. This case highlights ictal EEG as the main diagnostic tool for epileptic headache. We discuss the terminology regarding this type of manifestation and believe that cases without subsequent epileptic manifestations, as in the present case, should be more appropriately referred to as “pure ictal epileptic headache” or simply “pure epileptic headache”. [Published with video sequences]

Epileptic seizures and headache/migraine: A review of types of association and terminology

“…We recently described 15 a new case with video-EEG report, and briefly illustrated the cases available in the literature regarding this condition, for which we suggested the term of ''pure (or ''isolated'') epileptic headache''. To meet the criteria for this condition, at least some of the headache episodes experienced by the patients should be isolated episodes, without other manifestations of a clearly epileptic nature, and in particular should not be immediately followed by motor and/or sensory and/or autonomic manifestations.…”

“…The main features of 15 published cases affected by ''pure epileptic headache'' [15][16][17][18][19][20][21][22][23][24][25] are reported in Table 2. In the table, no data are provided for the first patients reported with epileptic headaches, [26][27][28][29] as the full text articles are unavailable.…”

Ictal Epileptic Headache in Occipital Symptomatic Epilepsy: Not Only a Matter of Cortex

“…Applying IEH criteria to current literature, 23 well‐documented reports can be found. By reviewing published cases, it was possible to define the different epileptic syndromes associated with IEH: idiopathic generalized epilepsy (2 cases), early encephalopathy (1 case), occipital Gastaut‐type epilepsy (1 case), unknown (6 cases) and structural focal epilepsy (13 cases) . Our patient has to be included in the context of structural focal epilepsy, the form observed in most published cases.…”

Epileptic Headache: Need for a Better Knowledge

“…Apart from the use of somewhat redundant terminology “ ictal epileptic headache” (an “epileptic headache” is necessarily “ictal,” as is every epileptic phenomenon; therefore the term “ictal” is redundant), Saitowitz and colleagues do not delineate this cephalic pain manifestation due to an epileptic event in their main characteristics. These main characteristics are simple and clear: “a headache of any type, with onset and (if not followed by other epileptic manifestations) with cessation coinciding with a (scalp or deep) EEG pattern of epileptic seizure” (a video‐EEG example has been published).…”

“…On the other hand, their second patient appears to really represent a case of epileptic headache: in fact he had an EEG record during a headache attack, showing “manifestations of an L frontal lobe seizure, with buildup of spike and slow waves to rhythmic fast beta activity overlying the L frontal region, lasting for 1 minute, and followed by L frontal delta slowing.” This is what is required and sufficient for a diagnosis of epileptic headache, although the authors do not stress this, instead choosing to overstate the importance of a differential diagnosis with primary stabbing headache, short‐lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and short‐lasting unilateral neuralgiform headache with autonomic symptoms (SUNA), disorders that instead can be immediately excluded since they not include epileptic abnormalities on the ictal EEG. From the clinical point of view, the interest of their case 2 is that it belongs to the isolated form of epileptic headache (“Pure epileptic headache”). In fact, diagnosis was made only after an ictal EEG, and this led to the correct therapy.…”