Postictal headache in South African adult patients with generalised epilepsy in a tertiary care setting: a cross-sectional study.
Postictal headache (PIH), although it occurs in 34-59% of epilepsy patients, has not been adequately studied. This study aims to describe clinical characteristics and associations of PIH in generalised epilepsy in a South African tertiary neurology clinic.


METHODS
Two-hundred consecutive adults with generalised epilepsy underwent semi-structured interviews, dividing them into study (with PIH) and control patients (no PIH), and data was statistically analysed.


RESULTS
PIH occurred in 104/200, with 63% having headache after every seizure. Pain duration was 4-24 hours in 43% and pain intensity severe in 55%. The criteria of the International Headache Society (2004), International Classification of Headache Disorders, second edition (ICHD-II) classified 47% as migraine, 38% tension-type and 15% unclassified (but 13% probable migaine). Self-medication occurred in 81% and interictal headache was significantly associated with PIH-present in 64% of study patients versus 5% of control patients.


CONCLUSIONS
PIH occurs commonly in generalised epilepsy, mostly as migraine headache, with interictal headache a specific risk factor. PIH is underdiagnosed and undertreated, leading to self-medication. Optimal management should be elucidated in future studies.
University of Pretoria, South Africa.
Stephanus Schmidt
SS
Botha
Clara-Maria
CM
Schutte
Steve
S
Olorunju
Mandisa
M
Kakaza
D000328:Adult; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000150:complications*; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D012640:Seizures / Q000150:complications*; D013019:South Africa / Q000453:epidemiology