title: Headache Following Occipital Brain Lesion: A Case of Migraine Triggered by Occipital Spikes?
abstract: This study describes the case of an 8-year-old boy who developed a genuine migraine after the surgical excision, from the right occipital lobe, of brain abscesses due to selective infestation of the cerebrum by Entamoeba histolytica. After the surgical treatment, the boy presented daily headaches with typical migraine features, including right-side parieto-temporal pain, nausea, vomiting, and photophobia. Electroencephalography (EEG) showed epileptiform discharges in the right occipital lobe, although he never presented seizures. Clinical and neurophysiological observations were performed, including video-EEG and polygraphic recordings. EEG showed "interictal" epileptiform discharges in the right occipital lobe. A prolonged video-EEG recording performed before, during, and after an acute attack ruled out ictal or postictal migraine. In this boy, an occipital lesion caused occipital epileptiform EEG discharges without seizures, probably prevented by the treatment. We speculate that occipital spikes, in turn, could have caused a chronic headache with features of migraine without aura. Occipital epileptiform discharges, even in absence of seizures, may trigger a genuine migraine, probably by means of either the trigeminovascular or brainstem system.
authors.affiliation: Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences & Orthopedics, Catholic University, Rome, Italy lvol@libero.it.
authors.forename: Catello
authors.initials: C
authors.lastname: Vollono
authors.affiliation: Paediatric Neurology Unit, Department of Paediatrics, Catholic University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Mariotti
authors.affiliation: Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences & Orthopedics, Catholic University, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Losurdo
authors.affiliation: Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences & Orthopedics, Catholic University, Rome, Italy.
authors.forename: Nadia Mariagrazia
authors.initials: NM
authors.lastname: Giannantoni
authors.affiliation: Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences & Orthopedics, Catholic University, Rome, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mazzucchi
authors.affiliation: Paediatric Neurology Unit, Department of Paediatrics, Catholic University, Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Valentini
authors.affiliation: Paediatric Neurology Unit, Department of Paediatrics, Catholic University, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: De Rose
authors.affiliation: Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences & Orthopedics, Catholic University, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D001927:Brain Diseases / Q000469:parasitology* / Q000601:surgery*; D002648:Child; D004569:Electroencephalography; D004748:Entamoeba histolytica; D004749:Entamoebiasis / Q000601:surgery*; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000209:etiology*; D059906:Neuroimaging; D009778:Occipital Lobe / Q000469:parasitology* / Q000601:surgery*
keywords: Entamoeba histolytica; brain abscess; electroencephalogram; epilepsy; migraine; occipital lobe; wavelet analysis