headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...

is often present in patients with

epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

. If the headache occurs in the vicinity of a

seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...

, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache or simply epileptic headache. It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity. __TOC__

Definitions

Pre-ictal headache. The most frequent pre-ictal headache is that of a seizure occurring during or within one hour after an attack of migraine with aura, defined Migraine aura-triggered seizure or Migralepsy. However, the condition can also occur in connection with an attack of migraine without aura or of a non-migrainous headache. Only an EEG during the headache can determine whether it is a true migraine or an epileptic headache (in this second case epileptiform anomalies are detectable during the headache phase). Post-ictal headache. It is a headache “occurring within three hours after an epileptic seizure and remitting spontaneously within 72 hours after seizure termination”. It is one of the possible symptoms of the postictal state. Post-ictal headache is the most frequent association between headache and epilepsy, occurring between 12% to 52% of people with epilepsy. Post-ictal headache has migrainous features in about half of the cases. It is more frequent after generalized tonic-clonic seizures, in temporal and occipital lobe epilepsy and in those with inter-ictal headache. Inter-ictal headache. Patients with epilepsy may also experience any type of headache, having its occurrence independent of the epileptic seizures, although occasionally near it (after or before). This is a comorbid condition, to be kept separate from the above-reported peri-ictal and ictal headaches.

Ictal headache

1.Ictal epileptic headache (IEH) or, more simply, Epileptic headache (EH, since the term "ictal" is pleonastic, as a headache manifestation of an epileptic seizure is by definition ictal). This is a rare form of painful seizure. EH may be the initial phase (so-called aura, necessarily with awareness) of an epileptic seizure, which then continues with other manifestations, for example

convulsions A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term ''convulsion'' is sometimes used as a s ...

. But EH is of greater clinical importance when it is an isolated event ("pure EH" ), i.e. not followed by other manifestations that clarify its epileptic nature. Symptoms and diagnosis. EH has no clinical elements allowing a diagnosis. The characteristics and location of the pain in EH can be different: sometimes migraine-like with or without aura, sometimes tension-type, sometimes indefinable. The duration of an episode of EH may last for seconds, but even for days (headache/status epilepticus ). For the diagnosis it is necessary to perform an EEG during the headache that shows epilepsy-compatible discharges coinciding with the onset and cessation of the headache. The so-called hemicrania epileptica is a variant of EH characterized by the fact that head pain and EEG paroxysms are located on the same side.

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

is necessary to establish the cause, which, as in all focal epilepsies, can be varied:

malformations A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

dysplasia Dysplasia is any of various types of abnormal growth or development of cells (microscopic scale) or organs (macroscopic scale), and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopic ...

neoplasms A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

encephalopathies Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...

traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic b ...

vasculopathies Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused by ...

. Therapy. It depends on the

etiology Etiology (pronounced ; alternatively: aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek (''aitiología'') "giving a reason for" (, ''aitía'', "cause"); and ('' -logía''). More completely, e ...

. During the headache, like most

seizures An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or neural oscillation, synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much o ...

, i.v. benzodiazepines are usually effective.

Antiepileptic drugs Anticonvulsants (also known as antiepileptic drugs or recently as antiseizure drugs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of b ...

can be used as preventive. 2. Ictal non-epileptic headache. Rare cases are reported. It is a condition that can be differentiated with certainty from the previous one if the headache episode is also present outside the seizure, that is, before and/or after, without specific EEG abnormalities.

References

External links

Seizures and Headaches: They Don't Have to Go Together
{{Headache Headaches