Headaches and their relationships to epileptic seizures

• Published in: Epilepsy & behavior 2019-01, Vol.90, p.233-237
• Main Authors: Salma, Zouari, Hanen, Haj Kacem, Salma, Sakka, Olfa, Hdiji, Nouha, Farhat, Mariem, Damak, Chokri, Mhiri
• Format: Article
• Language: English
• Subjects: Adult; Aged; Electroencephalography - methods; Electroencephalography - standards; Epilepsy; Female; Headache; Headache - diagnostic imaging; Headache - epidemiology; Headache - physiopathology; Humans; Ictal epileptic headache; Interictal headache; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - standards; Male; Middle Aged; Periictal headache; Seizures - diagnostic imaging; Seizures - epidemiology; Seizures - physiopathology; Self Report - standards; Young Adult
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2018.11.012

The frequent association between headache and epilepsy has been increasingly studied in recent years. Through this study, we attempted to study possible temporal associations between epileptic seizures and headaches. We also tried to describe clinical aspects of headache in our patients with epilepsy. We included patients with epilepsy and patients without epilepsy who presented for a first neurologic episode suggestive of epileptic seizure or unusual headache. These patients were invited to answer a standardized questionnaire screening for headache characteristics. Patients with epilepsy were asked for further data about their epilepsy. Electroencephalogram (EEG) was performed in all patients. Brain Magnetic resonance imaging MRI was reserved for patients in whom we suspected a structural lesion. Overall, we included 47 patients with a mean age of about 39 ± 15 years (19 to 68 years old) and a female predominance (Sex Ratio: SR = 1.47). Most frequently, our patients documented periictal headache (Peri-IH) (85.1%) including respectively ictal headache (IH: 31.9%); postictal headache (Post-IH: 21.3%), and preictal headache (Pre-IH: 4.3%). Less frequently, our patients noted interictal headache (Inter-IH: 31.9%). Interestingly, these subgroups exhibited different headache patterns with predominantly unclassified-type headache (U-TH) in patients with IH (72.7%), tension-type headache (T-TH) in patients with Post-IH (73.3%), and migraine-type headache (M-TH) in patients with Inter-IH (60%). Our results suggest that patients with epilepsy could exhibit different headache types. The clinical pattern of headache seemed to be linked to the time of seizure onset. •Headaches have different clinical patterns according to their temporal relationships with seizures.•There is no association of a particular type of headache with epilepsy syndrome or etiology, seizure origin and frequency.•Headache with possible epileptic origin should be explored using EEG in order to start or adjust antiepileptic drugs.