The crossover between headache and epilepsy

Parisi, Pasquale; Striano, Pasquale; Belcastro, Vincenzo

doi:10.1586/ern.13.16

Cited by 19 publications

(37 citation statements)

References 19 publications

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“…In this regard, it has previously been suggested that the IEH phenomenon be classified among "autonomic seizures", as happens for Panayiotopoulos syndrome [2,3,5,8,10]. It has also been suggested [2][3][4][5][11][12][13] that the age-specific lower activation threshold of the autonomic system ("the younger, the more autonomic") may explain the possible isolated headache manifestation during an epileptic seizure, as occurs in autonomic ictal manifestation for Panayiotopoulos syndrome in children [10].…”

Section: Discussion Of the Four Clinical-eeg Casesmentioning

confidence: 99%

“…It has been suggested [2][3][4][5][11][12][13][16][17][18][19][20][21][22] that the activation threshold for cortical spreading depression (CSD) is inferior to that required for an epileptic seizure. This theory would explain why epileptic patients presenting a peri-ictal headache are seen considerably more often than migraine patients presenting an epileptic seizure.…”

Section: "Ictal Epileptic Headache" Conceptmentioning

confidence: 99%

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Diagnostic criteria currently proposed for “ictal epileptic headache”: Perspectives on strengths, weaknesses and pitfalls

Parisi

Verrotti

Costa

et al. 2015

Seizure

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EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epileptic patient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.

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Section: Discussion Of the Four Clinical-eeg Casesmentioning

confidence: 99%

Section: "Ictal Epileptic Headache" Conceptmentioning

confidence: 99%

Diagnostic criteria currently proposed for “ictal epileptic headache”: Perspectives on strengths, weaknesses and pitfalls

Parisi

Verrotti

Costa

et al. 2015

Seizure

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“…We believe that this has led to ictal epileptic headache being severely underestimated, on the one hand, and to migralepsy being clearly overestimated, on the other (Parisi et al 2012b(Parisi et al , 2013a.…”

Section: Sunset Of the "Migralepsy" Conceptmentioning

confidence: 91%

“…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.…”

Section: Sunset Of the "Migralepsy" Conceptmentioning

confidence: 99%

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

Parisi

2014

Contemporary Clinical Neuroscience

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Key Points-Headache/migraine is often associated with epilepsy in children, as a pre-ictal, ictal, post-ictal or inter-ictal phenomenon.-Epidemiological aspects of the co-morbidity between epilepsy and headache are clearly different in children and adults.-Headache as a symptom, with migraine characteristics and/or tension-type headache characteristics, may be the only clinical ictal manifestation of an epileptic seizure: this condition is now classified as "ictal epileptic headache".-In particular, according to published criteria, the term "ictal epileptic headache" must be used in cases of a headache/migraine attack as the sole clinical ictal symptom of epileptic origin, confirmed by ictal-EEG recording and clinical-EEG responsiveness to intravenous antiepileptic drugs.-EEG is not recommended as a routine examination for children diagnosed with headache, but is mandatory and must be carried out promptly in cases of prolonged migraine/headache that does not respond to antimigraine drugs and in which epilepsy is suspected.-This is not a marginal question, because these possible, isolated, non-motor, ictal manifestations (i.e. ictal epileptic headache) should be taken into account before declaring an epileptic patient as "seizure free" so as to be able to suspend anticonvulsant therapy safely. SummaryThe possible link/comorbidity (causal or not causal) between epilepsy and headaches has been a topic of debate for over a hundred years, ever Since William Richard Gowers's time. In recent decades, new data have emerged in favor of a non-random relationship between these two entities. They are both characterized by transient attacks of altered brain function with a clinical, pathophysiological, genetic and therapeutic overlap, and may thus mimic each other. Indeed, the clinical distinction between headache and epilepsy may make the differential diagnosis a highly challenging task. Both are common and often co-morbid, with headache attacks in epilepsy being temporally related to the occurrence of epileptic seizures as a pre-ictal, ictal, post-ictal or inter-ictal event. Yet, they are both paroxysmal and chronic neurological disorders that share many clinical and epidemiological aspects, and they may both present with visual, cognitive, sensitive-sensorial and motor signs/symptoms; these neurophysiologicl phenomena arise from the cerebral cortex and are modulated by sub-cortical connections. Even from an epidemiological point of view, data in the literature regarding the co-morbidity between headache and epilepsy appear to be quite distinct in children. What makes this scenario even more variegated and complex are new data suggesting that a headache may, in some cases, even be the only ictal manifestation of an epileptic seizure. The latter condition, the so-called "ictal epileptic headache", is a new entity that has recently been cited in the new classification of headache disorders (ICHD-III), whose diagnostic criteria have very recently been defined and published. The data that have led, over the last decade, to the...

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“…Literature data support the view that in IEH (as it happen for autonomic manifestations in Panayiotopoulos syndrome), the ictal EEG anomalies can be focal or generalized, recordable ipsilaterally or contralaterally and associated with the same manifestations (headache) which can be of any types (migraine with or without aura, tensiontype headache, etc.). In addition, in IEH cases, electroencephalogram (EEG) abnormalities may only be recorded using depth electrodes (3)(4)(5) We hope that going forward we will have the opportunity to confront questions of deep and substantive importance. In the meanwhile, we discourage the use of additional terms, such as ''isolated'' or ''pure'' epileptic headache, which could potentially increase confusion surrounding this topic.…”

Section: To the Editormentioning

confidence: 99%