Migraine in the borderland of epilepsy: “Migralepsy” an overlapping syndrome of children and adults?

Trenité, Dorothee Kasteleijn‐Nolst; Parisi, Pasquale

doi:10.1111/j.1528-1167.2012.03711.x

Cited by 32 publications

(34 citation statements)

References 37 publications

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“…Children are more likely to have an autonomic symptomatology in both epilepsy and headache attacks (Fogarasi et al 2006;Kasteleijn-Nolst Trenité and Parisi 2012). Moreover, they may have isolated, long-lasting ictal autonomic manifestations, while ictal autonomic manifestations (in both epilepsy and headache) in adults are usually associated, whether simultaneously or sequentially, with other motor or sensory ictal signs and symptoms (Fogarasi et al 2006;Kasteleijn-Nolst Trenité and Parisi 2012). Furthermore, it should be borne in mind, despite the limited number of studies in the literature (Yamamane et al 2004;Piccinelli et al 2006;Toldo et al 2010), that the framework assumes markedly different shapes in the pediatric population.…”

Section: Epidemiological Issues: Beyond the Controversial Evidencementioning

confidence: 99%

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

Parisi

2014

Contemporary Clinical Neuroscience

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Key Points-Headache/migraine is often associated with epilepsy in children, as a pre-ictal, ictal, post-ictal or inter-ictal phenomenon.-Epidemiological aspects of the co-morbidity between epilepsy and headache are clearly different in children and adults.-Headache as a symptom, with migraine characteristics and/or tension-type headache characteristics, may be the only clinical ictal manifestation of an epileptic seizure: this condition is now classified as "ictal epileptic headache".-In particular, according to published criteria, the term "ictal epileptic headache" must be used in cases of a headache/migraine attack as the sole clinical ictal symptom of epileptic origin, confirmed by ictal-EEG recording and clinical-EEG responsiveness to intravenous antiepileptic drugs.-EEG is not recommended as a routine examination for children diagnosed with headache, but is mandatory and must be carried out promptly in cases of prolonged migraine/headache that does not respond to antimigraine drugs and in which epilepsy is suspected.-This is not a marginal question, because these possible, isolated, non-motor, ictal manifestations (i.e. ictal epileptic headache) should be taken into account before declaring an epileptic patient as "seizure free" so as to be able to suspend anticonvulsant therapy safely. SummaryThe possible link/comorbidity (causal or not causal) between epilepsy and headaches has been a topic of debate for over a hundred years, ever Since William Richard Gowers's time. In recent decades, new data have emerged in favor of a non-random relationship between these two entities. They are both characterized by transient attacks of altered brain function with a clinical, pathophysiological, genetic and therapeutic overlap, and may thus mimic each other. Indeed, the clinical distinction between headache and epilepsy may make the differential diagnosis a highly challenging task. Both are common and often co-morbid, with headache attacks in epilepsy being temporally related to the occurrence of epileptic seizures as a pre-ictal, ictal, post-ictal or inter-ictal event. Yet, they are both paroxysmal and chronic neurological disorders that share many clinical and epidemiological aspects, and they may both present with visual, cognitive, sensitive-sensorial and motor signs/symptoms; these neurophysiologicl phenomena arise from the cerebral cortex and are modulated by sub-cortical connections. Even from an epidemiological point of view, data in the literature regarding the co-morbidity between headache and epilepsy appear to be quite distinct in children. What makes this scenario even more variegated and complex are new data suggesting that a headache may, in some cases, even be the only ictal manifestation of an epileptic seizure. The latter condition, the so-called "ictal epileptic headache", is a new entity that has recently been cited in the new classification of headache disorders (ICHD-III), whose diagnostic criteria have very recently been defined and published. The data that have led, over the last decade, to the...

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Section: Epidemiological Issues: Beyond the Controversial Evidencementioning

confidence: 99%

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

Parisi

2014

Contemporary Clinical Neuroscience

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“…Children are more likely to have an autonomic symptomatology both in epilepsy and headache attacks, and moreover, they can experience isolated long-lasting ictal autonomic manifestations, while in adults ictal autonomic manifestations (both in epilepsy and headache) are usually associated, simultaneously or sequentially, with other motor or sensory ictal signs and symptoms [15]. In this regard, we have recently suggested to include 'ictal headache' among the ictal autonomic manifestations in both headache and epilepsy international classifications, which until now have always ignored each other [1,[6][7][8][10][11][12]16].…”

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“…According to our recently proposed criteria [2] for IEH, there are serious doubts about the real existence of the phenomenon called 'migralepsy' [1,10,15]. Recent scientific evidences on the ictal epileptic headache' have convinced us that the 'migralepsy' concept is exceptional or even it does not exist.…”

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The crossover between headache and epilepsy

Parisi

Striano

Belcastro

2013

Expert Review of Neurotherapeutics

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“…In migraines EEG most often shows unspecific, non-epileptiform changes, however if specific grapho-elements are registered it is clear that there is the presence of epileptic headache (7,8). The term "migralepsy", which is still used today in the terminology of headaches, and indicates the epileptic seizure during or after the migraine aura, is increasingly often changed by the term epileptic headachehemicrania epileptic, which suggests that the headache is, for example, primarily of epileptic and not of migraine etiology (6,11). Headaches are often nonspecific clinical manifestations of epilepsy; they frequently develop as the result of general organism and brain fatigue after GTC seizure.…”

Section: Discussionmentioning

confidence: 99%

“…Headaches are often nonspecific clinical manifestations of epilepsy; they frequently develop as the result of general organism and brain fatigue after GTC seizure. In relation to the epileptic seizure, in epilepsies headaches are classified as preictal (prodrom seizures), ictal, postictal and interictal (10,11). In the epilepsies of the occipital lobe, headache is a frequent manifestation showing characteristic of seizures; inctalare of shorter duration, while the postictal last longer and have the characteristics of migraine.…”

Section: Discussionmentioning

confidence: 99%

Occipital lobe epilepsy or migraine headache

Skrijelj

Mulić

2016

SANAMED

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Introduction: Occipital lobe epilepsies are rarely met in clinical practice, but when they occur, they can be misdiagnosed as migraine-like headache. Their prevalence ranges from 5% to 10% of all epilepsies. Seizures can occur at any age; etiologically speaking they can be symptomatic, cryptogenic and idiopathic (most often onsetis in childhood). Clinical symptomatology is manifested by partial epileptic seizures in the sense of visual elementary and/or complex manifestations, palinopsia, amaurosis, tonic head deviation, bulbus, nistagmus and headache. Propagation discharge to neighbour areas (temporal, parietal and frontal) is a frequent occurrence appearing with complex partial seizures frequently finishing with secondary generalized tonic-clonic (GTC) seizures. Case report: We are presenting a17-year-old male patient who has suffered from attacks of visual problems with headache since 10 years of age. All the time it is treated as a migraine headache. During the last attack of headache the patient also had a loss of consciousness, EEG that was performed for the first time evidenced epileptic discharges of the occipital area.The therapy also included treatment with antiepileptic drug pregabalin resulting in seizure withdrawal. Conclusion:The appearance of visual symptoms followed by headache is most frequently qualified as migraine triggered headache. However, when antimigraine therapy does not give favorable results epileptic headache should be suspected, with obligatory performance of EEG recording. Occipital lobe epilepsy often presents diagnostic dilemmas due to clinical manifestations that are similar to that of non-migraine headache.

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Migraine in the borderland of epilepsy: “Migralepsy” an overlapping syndrome of children and adults?

Cited by 32 publications

References 37 publications

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache

The crossover between headache and epilepsy

Occipital lobe epilepsy or migraine headache

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