Characteristics of Postictal Headache in Patients with Partial Epilepsy

Abstract

Migraine-like features sometimes characterize the headache that follows epileptic seizure (postictal headache, PIH). We compared patients with different types of epilepsy to investigate the association between migraine-like PIH and seizure type. Subjects comprised 364 patients with partial epilepsy. Epilepsy types were temporal lobe epilepsy (TLE, n = 177), frontal lobe epilepsy (FLE, n = 116), and occipital lobe epilepsy (OLE, n = 71). Patients participated in a structured interview pertaining to PIH as well as interictal headache and family history of migraine. Headaches were classified according to the International Headache Society criteria, which was modified for this study. Forty percent had PIH and 26% of these patients had migraine-like PIH. Migraine-like PIH occurred significantly more often in cases of TLE and OLE than in cases of FLE. In addition, the incidence of interictal migraine headache was significantly higher in patients with migraine-like PIH. These results suggest that migraine-like PIH is related to particular regions of epileptogenic focus and that susceptibility to migraine headache predisposes to migraine-like PIH.

The Prevalence of Migraine and Tension Type Headaches among Epileptic Patients

“…Our results are close to the prevalence of 5-15% for pre-ictal headache that was reported in epilepsy and of especially 11% in pharmacologically refractory partial epilepsy (29)(30)(31). Similar to our findings, in the other studies, post-ictal headaches are more common than pre-ictal headaches which are often the migraine type and especially occur after some types of epilepsy such as generalized tonic-clonic and occipital lobe epilepsies (1,29,32,33). Limitations of this study were small sample size, prospective nature of the study and undifferentiated epileptic syndromes.…”

Headaches add to the burden of epilepsy

“…These findings are in accordance with our study. Ito et al found somewhat lower numbers, 29% and 26% [4,10]. They also found an association between postictal and interictal migraine.…”

“…These findings support the hypothesis of a common pathophysiology for post-and interictal headache, and also that seizures may serve as one of several triggering factors for headache. It has been demonstrated that migraine-like postictal headaches occur more often with seizure onset in the posterior parts of the brain compared with frontal lobe onset [10].…”

“…It may occur prior to a seizure (preictal headache), during a seizure (ictal headache), after a seizure (postictal headache) or be unrelated to seizures (interictal headache). Preictal headaches have been reported in 4-15% of patients with epilepsy; ictal headaches are rare, whereas postictal and interictal headaches are common with a frequency of 35%-51% and 31%-64%, respectively [1][2][3][4][5][6][7][8][9][10][11][12].…”

Postictal headache in epileptic patients

“…The percentage of those with PIH ranges between 12% and 52% [3][4][5] , implying that PIH adds an additional significant burden to persons with epilepsy in addition to actual seizures. We have investigate the incidence of PIH and the factors potentially related to the occurrence of PIH in a Chinese epileptic center, from Feb. 01, 2012 to May 10, 2013, which based on the guideline of ICHD-II.PIH occurred in 328 (38%) of the subjects, and the incidence of PIH in occipital lobe epilepsy (OLE, 56%) was significantly higher than in temporal lobe epilepsy (TLE, 35%) and frontal lobe epilepsy (FLE, 39%).…”