Characteristics of Post-Ictal Headaches in Patients with Epilepsy: a Longitudinal Study

Abstract

This study aimed to investigate the clinical predictors of post-ictal headache (PIH) in patients with epilepsy in a tertiary center in Brazil. Methods: 302 individuals with adult-onset epilepsy were followed for 9.8 years in our Hospital. Structured questionnaires about headaches were applied. The presence of PIH was the primary outcome. We used multilevel linear modeling in our data analysis. Results: From the total, 46.3% had post-ictal headaches. Tension-type post-ictal headache was present in 55% (N = 77) of the subjects, migrainous in 32.1% (N = 45), and both types in 12.8% (N = 18). Family history of migraine (Odds ratio: 1.696; 95% CI: 1.372 to 2.096), diagnosis of drug-resistant epilepsy (Odds ratio: 1.169; 95% CI: 1.135 to 2.146), months since last visit (Odds ratio: 1.464; 95% CI: 1.243 to 2.888), and generalized seizure onset type of epilepsy (Odds ratio: 1.527; 95% CI: 1.114 to 1.668), were significant determinants of PIH on multilevel linear modeling. Discussion: PIH are associated with drug-resistant epilepsy, generalized seizures, and family history of migraine. The rates of pos-ictal headaches could be influenced by the use of antiepileptic drugs.

Primary headache types in adult epilepsy patients

“…This is consistent with previous studies which reported a prevalence of any seizure-associated headache up to 47% in epileptic patients [36][37][38][39]. Postictal headache was the most common seizure-associated headache in our cohort which is in line with previous findings in adult patients with epilepsy [40]. Postictal headache was found to be associated to drug-resistance, generalised epilepsy and family history [40].…”

“…Postictal headache was the most common seizure-associated headache in our cohort which is in line with previous findings in adult patients with epilepsy [40]. Postictal headache was found to be associated to drug-resistance, generalised epilepsy and family history [40]. Furthermore, there was a weak association between headache and seizure freedom: patients with headache were more likely to not be seizure-free compared to patients without headache.…”

A Narrative Review of Visual Hallucinations in Migraine and Epilepsy: Similarities and Differences in Children and Adolescents

“…In fact, as shown in a multilevel linear modeling study involving 302 subjects, the factors that most influenced the occurrence of PIH are a family history of migraine, drug-resistant epilepsy, and subjects generalized seizure onset type. Other [ 72 ] associations with PIH reported by previous authors include a younger age of onset of epilepsy [ 71 ]. These data are confirmed in the pediatric population.…”

Headache in patients with epilepsy: ictal epileptic headache and postictal headache

“…PIH는 뇌전증 환자의 약 37%-51%가 호 소하는, 비교적 높은 유병률을 가진 흔한 증상이다. 19 최근 뇌전 증 환자에서 두통에 대해 역학 조사한 연구들을 메타 분석한 체 계적 문헌고찰에 따르면, 뇌전증 환자에서의 두통 중 PIH가 43.1%로 가장 많았으며, 특히 남자보다는 여성 환자가 더 두통 을 호소하는 것으로 보고되었다. 20 PIH의 임상적 특징을 살펴보 면, 약 50% 이상은 편두통양 두통을 호소하고, 이러한 두통은 측 두엽 뇌전증 또는 전두엽 뇌전증 환자의 40% 이상, 후두엽 뇌전 증 환자의 60%까지 나타난다.…”