Seizure-associated headache in epilepsy.
OBJECTIVE
Headache is often ignored as a symptom of epileptic seizures. The purpose of this prospective study was to analyze frequency, classification, and characteristics of seizure-associated headache (SH) according to the criteria of the International Headache Society.


METHODS
Over a period of 15 months, 341 patients with epilepsy, consecutively evaluated at our outpatient clinic for SH, completed a standardized questionnaire.


RESULTS
Of the 341 epilepsy patients, 115 (34%) experienced SH with a pain intensity of 6.1 +/- 1.6 (SD) on the visual analogue scale and a duration of 12.8 +/- 15.7 (SD) h. Seizures were always accompanied by headache in 69 (60%) of these 115 patients. SH occurred in four (3%) of 115 patients only preictally, in 31 (27%) of 115 patients periictally, and in 80 (70%) of 115 patients only postictally. In the majority of the 115 patients (55.7%), SH could be classified as migraine headache, whereas in 36.5%, as tension-type headache. The type of SH was not correlated with sex, an epilepsy syndrome, or a seizure type. Migraine-like SH was significantly associated with a history of migraine (p < 0.001). In 20 (77%) of the 26 patients experiencing migraine-like SH with a history of migraine, the phenomenology of migraine-like SH and migraine attacks was identical.


CONCLUSIONS
SH is a frequent, long-lasting, and severe symptom of epileptic seizures, causing major impairment of daily living. A history of migraine significantly increases the risk for developing migraine-like SH.
Leniger
T
T
Department of Neurology, University of Essen, Essen, Germany. tobias.leniger@uni-essen.de
Isbruch
K
K
von den Driesch
S
S
Diener
H C
HC
Hufnagel
A
A
D000328:Adult; D000553:Ambulatory Care; D015897:Comorbidity; D004827:Epilepsy / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000453:epidemiology; D010147:Pain Measurement / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000175:diagnosis / Q000453:epidemiology