Comorbidity between headache and epilepsy in a pediatric headache center

Abstract

The purpose of this study was to analyse the comorbidity between headache and epilepsy in a large series of children with headache (1,795). Fifty-six cases (3.1%) suffered from idiopathic headache and idiopathic or cryptogenic epilepsy or unprovoked seizures. There was a strong association between migraine and epilepsy: in migraineurs (46/56) the risk of epilepsy was 3.2 times higher when compared with tension-type headache, without significant difference between migraine with and without aura (P = 0.89); children with epilepsy had a 4.5-fold increased risk of developing migraine than tension-type headache. In cases with comorbidity, focal epilepsies prevailed (43/56, 76.8%). Migraineurs affected by focal epilepsies (36/56) had a three times higher risk of having a cryptogenic epilepsy (27/36, 75%) than an idiopathic epilepsy (9/36, 25%) (P = 0.003). In migraine with aura, epilepsy preceded migraine in 71% of cases. Photosensitivity (7/56, 12.5%) and positive family history for epilepsy (22/56, 39%) were frequent in cases with comorbidity.

The Prevalence of Migraine and Tension Type Headaches among Epileptic Patients

“…Moreover, this finding has been also confirmed by other studies (17,18). In another study, Toldo et al documented that epilepsy is 3.2 times higher than in migrainous patients and they did not find the same association with tension type headache and the difference between migraine with and without aura in this regard (19).…”

Postictal headache in epileptic patients

“…In a pediatric population, there was no correlation between IIH and PIH and no tendency for children with IIH migraine to have migrainous PIH [9] . Similarly, another study reported that children with migraine did not increase the risk of PIH than the children with tension-type headache [11] . Interestingly, no association has been found between family history of headaches or migraine and PIH.…”

“…However, some studies that addressed pediatric population found a lower prevalence of PIH (12-36%) [9,11,12] than in most adult studies (30-52%) [13,14] . In 2011, Verrottiet al conformed [15] a cross-sectional multi-center study, which includes 1,264 epileptic children.…”

“…Velioglu and colleagues [19] observed that patients with migraine were significantly more likely to have intractable seizures and to require antiepileptic drug poly therapy for seizure control than patients with epilepsy without migraine. However, Toldo [11] and Yamane [20] reported that headaches began predominantly either in the same year of the epilepsy onset or after the epilepsy, which indicated the inverse causal relationships between IIH or migraine and epilepsy or shared neuropathological mechanisms. Indeed, the bidirectional influences between IIH and epilepsy in general and PIH in particular are complex.…”

Cross section comparative study for comorbid migraine and major depression in epileptic patients: demographic, clinical, electroencahpalograhy and therapeutic implications

“…The prevalence of migraine in populations of individuals with epilepsy is estimated as 8-24% (Toldo et al, 2010), so that the risk of migraine is approximately twice that in the normal population (Ottman & Lipton, 1994).…”