title: Diagnostic criteria currently proposed for "ictal epileptic headache": Perspectives on strengths, weaknesses and pitfalls.
abstract: OBJECTIVE
  When we published the diagnostic criteria for "ictal epileptic headache" in 2012, we deliberately and consciously chose to adopt restrictive criteria that probably underestimate the phenomenon, rather than spread panic among patients and physicians who are reluctant to accept this entity.
  
  
  METHODS
  Here we discuss four intriguing clinical cases to highlight why we believe, to this day, that it is necessary to follow these restrictive diagnostic criteria.
  
  
  CONCLUSIONS
  EEG is not recommended as a routine examination for children diagnosed with headache, but it is mandatory and must be carried out promptly in cases of prolonged headache that does not respond to antimigraine drugs, if epilepsy is suspected or has been diagnosed previously. This is not a marginal or irrelevant question because possible isolated, non-motor, ictal manifestations should be taken into account before declaring that an epileptic patient is "seizure free" so as to ensure that any decision taken to suspend anticonvulsant therapy is safe.
authors.affiliation: Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy. Electronic address: pasquale.parisi@uniromal.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Parisi
authors.affiliation: Department of Pediatrics, University of Perugia, Perugia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.affiliation: Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Costa
authors.affiliation: Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
authors.affiliation: Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Zanus
authors.affiliation: Neuropsychiatry Ward, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carrozzi
authors.affiliation: Emergency Pediatric Department, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Raucci
authors.affiliation: Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Villa
authors.affiliation: Neurology Clinic, Department of Neuroscience, Sant'Anna Hospital, Como, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Belcastro
mesh_terms: D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male
keywords: Autonomic seizures; Autonomic status epilepticus; Epilepsy; Headache; Ictal epileptic headache; Migraine; Status migrainosus; Tension-type headache