title: Exploring two novel cases of suspected ictal epileptic headache, a rare form of paediatric epilepsy.
abstract: OBJECTIVE
  Ictal epileptic headache (IEH) is a rare and underestimated epileptic form, characterised by epileptiform discharges and headache attacks without any other ictal sensory-motor manifestations. IEH is difficult to diagnose, because the epileptiform discharges have to be registered during the headache attack and the headache has to disappear after the intravenous administration of an anti-epileptic drug, according to the last diagnostic criteria. This study explored the clinical, neuro-physiological and therapeutic features of IEH in the paediatric population.
  
  
  METHODS
  We analysed two novel cases of adolescent female patients with chronic headache and a long history of unsuccessful analgesic oral therapy and without any other ictal sensory-motor events. We also reviewed the entire literature on paediatric IEH.
  
  
  RESULTS
  The clinical history and diagnostic process led us to highly suspect IEH in both patients, and the successful therapy with oral anti-epileptic drugs, namely topiramate and ethosuximide, which resolved the chronic headache, enforced our diagnostic hypothesis. Our literature review highlighted the rarity of IEH clinical reports, particularly in the paediatric population, mainly due to the stringent diagnostic criteria.
  
  
  CONCLUSIONS
  Our study sheds further light on IEH in the paediatric population and on the importance of diagnostic electroencephalograms in the clinical management of paediatric patients suffering from chronic headache.
authors.affiliation: Center of Social Pediatrics and Pediatric Neurology, General Hospital of Celle, Celle, Germany.|Department of Neuropediatrics, University Children's Hospital, Ruhr University of Bochum, Bochum, Germany.
authors.forename: Emanuele G
authors.initials: EG
authors.lastname: Coci
authors.affiliation: Center of Social Pediatrics and Pediatric Neurology, General Hospital of Celle, Celle, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Riedel
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000209:etiology*; D006801:Humans
chemical_list: D000927:Anticonvulsants
keywords: Cortical spreading depression; Ethosuximide; Ictal epileptic headache; Topiramate; Trigeminovascular system