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. 2015:16:556.
doi: 10.1186/s10194-015-0556-y. Epub 2015 Aug 6.

Headache in epilepsy: prevalence and clinical features

G Mainieri  1 , S Cevoli, G Giannini, L Zummo, C Leta, M Broli, L Ferri, M Santucci, A Posar, P Avoni, P Cortelli, P Tinuper, Francesca Bisulli
Affiliations

Headache in epilepsy: prevalence and clinical features

G Mainieri et al. J Headache Pain. 2015.

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.

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Figures

Fig. 1
Fig. 1
Flow diagram of enrolled patients. Patients recruited from a pool of 454 subjects referred to the Bologna Epilepsy Center. Thirty-six patients excluded after medical review of their clinical records that did not confirm a diagnosis of epilepsy
Fig. 2
Fig. 2
Flow chart describing patients presenting headache. This subgroup is further divided into patients with inter-ictal headache and patients with peri-ictal headache, with an overlapping group of individuals who presented both conditions. Inter-IH, inter-ictal headache; Peri-IH, peri-ictal headache
See this image and copyright information in PMC

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