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

Abstract

The relationship between headache and epilepsy is complex, and the nature of this association remains unclear. The terms ictal epileptic headache (IEH) and postictal headache (PIH) have been increasingly used in the last 10 years to define a headache as an isolated symptom of epileptic seizure, and these terms are now recognized in the criteria of the International Classification of Headache Disorders, 3rd edition. A clinical depiction and electroencephalography in patients with suspected IEH are mandatory to achieve a correct diagnosis. PIH is often a comorbidity in patients with epilepsy. However, this condition is usually neglected in clinical practice because the motor manifestations and other features of a seizure are sometimes comparatively more dramatic and impactful for patients and their families. This review discusses IEH criteria and the clinical, historical, epidemiological, and pathophysiological characteristics of IEH itself. In addition, issues regarding the prevalence, characteristics, and clinical predictors of PIH are presented.