Ictal Epileptic Headache in Occipital Symptomatic Epilepsy: Not Only a Matter of Cortex

Ictal Epileptic Headache in an Elderly Patient with a Hippocampal Tumor

“… 3 4 In the literature, the origin of ictal headache has been predominantly reported to be the occipital lobe, and ictal headache most commonly occurs in young individuals. 2 4 5 Here we report an elderly patient with a hippocampal tumor who presented with ictal headache as the sole manifestation. This is a rare case of the ictal events being documented with video-EEG recordings.…”

“…Seizure-related headache has been subdivided into four types based on the temporal relationship: preictal headache, ictal headache, postictal headache, and interictal headache. 1 Ictal headache is a very rare type of seizure-related headache, 2 which has resulted in video-EEG recordings of ictal headache being exceptionally rare. 3 4 In the literature, the origin of ictal headache has been predominantly reported to be the occipital lobe, and ictal headache most commonly occurs in young individuals.…”

“…Headache has previously been associated with activation of the trigeminovascular system. 2 3 Cortical spreading depression is an electrophysiological phenomenon representing a neuronal depolarization wave followed by the suppression of bioelectrical activity. 2 3 This phenomenon is proposed to induce activation of the trigeminovascular system, which accompanies epileptic discharge, resulting in ictal headache.…”

“… 2 3 Cortical spreading depression is an electrophysiological phenomenon representing a neuronal depolarization wave followed by the suppression of bioelectrical activity. 2 3 This phenomenon is proposed to induce activation of the trigeminovascular system, which accompanies epileptic discharge, resulting in ictal headache. 2 3 Another plausible explanation is the association with synaptic transmission in the trigeminal nucleus.…”

“… 2 3 This phenomenon is proposed to induce activation of the trigeminovascular system, which accompanies epileptic discharge, resulting in ictal headache. 2 3 Another plausible explanation is the association with synaptic transmission in the trigeminal nucleus. Antiepileptic drugs (AEDs) did not suppress the cortical spreading depression observed in an experimental study, but ictal headaches are typically well controlled by AEDs, which are associated with the blockage of synaptic transmission.…”