title: Ictal epileptic headache in adult life: Electroclinical patterns and spectrum of related syndromes.
abstract: OBJECTIVE
  Both headache and epilepsy are frequent paroxysmal disorders that often co-occur or are related in numerous ways. Although ictal epileptic headache has become the focus of several studies, this remains a very rare and not well-known phenomenon. Electroclinical features, pathophysiology, and syndromic context are heterogeneous. We investigated the electroclinical and neuroimaging findings in a population of adult patients with ictal epileptic headache.
  
  
  METHODS
  We retrospectively examined 8800 EEG recordings of almost 4800 patients admitted to our video-EEG laboratory from 2010 to 2013 with a history of well-documented epilepsy. We selected patients who reported headache closely related to a seizure documented by video-EEG or 24-hour ambulatory EEG. We analyzed ictal electroclinical features of headache, and we defined the related epileptic syndromes.
  
  
  RESULTS
  We identified five patients with ictal epileptic headache. Two patients described tension headache during an epileptic seizure. In three patients, the headache was accompanied by other "minor" neurological symptoms mimicking a migrainous aura. In all cases, the headache stopped with the end of the epileptic activity. Three patients had a history of partial symptomatic epilepsy with cerebral lesions (low grade glioma, astrocytoma, porencephalic cyst) in the left posterior regions, whereas two patients were affected by idiopathic generalized epilepsy.
  
  
  CONCLUSIONS
  This study confirms the rarity of ictal epileptic headache. To date, well-documented video-EEG cases remain as exceptional reports, especially in cases of idiopathic generalized epilepsies. Moreover, we confirm the main involvement of posterior regions in patients with ictal epileptic headache affected by partial symptomatic epilepsies.
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Fanella
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Morano
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Jinane
authors.initials: J
authors.lastname: Fattouch
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Mariarita
authors.initials: M
authors.lastname: Albini
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
authors.forename: Anna Teresa
authors.initials: AT
authors.lastname: Giallonardo
authors.affiliation: Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy. Electronic address: c_dibonaventura@yahoo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Bonaventura
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D012189:Retrospective Studies; D013577:Syndrome
keywords: Cortical spreading depression; Epilepsy; Headache; Ictal epileptic headache