Epileptic Headache

1. Ictal Epileptic Headache
Ade Wijaya, MD
May 2018

2. Headache and Epilepsy

3. Introduction
 A headache episode as the sole ictal epileptic manifestation of an epileptic seizure.
 Both in pediatric age and in an adult population
 Rare
Parisi, P., Striano, P., Kasteleijn-Nolst Trenite, D.G.A. et al. “Ictal Epileptic Headache”: recent concepts for new classifications criteria. Cephalalgia. 2012; 32: 723–724

4. Diagnostic Criteria
Parisi, P., Striano, P., Kasteleijn-Nolst Trenite, D.G.A. et al. “Ictal Epileptic Headache”: recent concepts for new classifications criteria. Cephalalgia. 2012; 32: 723–724

5. Pathophysiology
 Cortical spreading depression
 Diffusion-weighted MRI has identified signal alterations in the region of seizure
activity
Parisi P. The complex relationship between epilepsy and headache and the concept of ictal epileptic headache. InEpilepsy towards the next decade 2015 (pp. 139-162). Springer, Cham.

6. Classification
 Isolated EH
 EH followed by other seizure manifestations
Cianchetti C, Dainese F, Ledda MG, Avanzini G. Epileptic headache: A rare form of painful seizure. Seizure-European Journal of Epilepsy. 2017 Nov 1;52:169-75.

7. Summary
 It is important to suspect, recognize and diagnose IEH, in order to avoid
misdiagnoses, incorrect therapy and an excessive number of examinations.
 EEG is not recommended as a routine examination for children diagnosed with
headache, but should be considered mandatory and be carried out promptly in
cases of a prolonged headache that does not respond to antimigraine drugs