title: Headache in epilepsy: prevalence and clinical features.
abstract: BACKGROUND
  Headache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy.
  
  
  METHODS
  All patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ(2)-test, t-test and Mann-Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH.
  
  
  RESULTS
  Out of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P < 0.001). Post-ictal headache (post-IH) was significantly associated with both migraineurs (OR 2.60, 95 % CI 1.85-3.64, P < 0.001) and TTH patients (OR 2.05, 95 % CI 1.41-2.98, P < 0.001). Moreover, post-IH was significantly associated with antiepileptic polytherapy (P < 0.001), high seizure frequency (P = 0.002) and tonic-clonic seizures (P = 0.043).
  
  
  CONCLUSIONS
  Migraine was the most represented type of headache in patients with epilepsy. Migraineurs are more prone to develop pre-IH, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post-IH after seizures.
authors.affiliation: IRCCS Istituto delle Scienze Neurologiche di Bologna, AUSL di Bologna, Bologna, Italy, greta.mainieri@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Mainieri
authors.forename: S
authors.initials: S
authors.lastname: Cevoli
authors.forename: G
authors.initials: G
authors.lastname: Giannini
authors.forename: L
authors.initials: L
authors.lastname: Zummo
authors.forename: C
authors.initials: C
authors.lastname: Leta
authors.forename: M
authors.initials: M
authors.lastname: Broli
authors.forename: L
authors.initials: L
authors.lastname: Ferri
authors.forename: M
authors.initials: M
authors.lastname: Santucci
authors.forename: A
authors.initials: A
authors.lastname: Posar
authors.forename: P
authors.initials: P
authors.lastname: Avoni
authors.forename: P
authors.initials: P
authors.lastname: Cortelli
authors.forename: P
authors.initials: P
authors.lastname: Tinuper
authors.forename: Francesca
authors.initials: F
authors.lastname: Bisulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult