Headache in epilepsy: prevalence and clinical features
TL;DR: Migraine was the most represented type of headache in patients with epilepsy, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post- IH after seizures.
Abstract: Headache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy. All patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ2-test, t-test and Mann–Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH. Out of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P < 0.001). Post-ictal headache (post-IH) was significantly associated with both migraineurs (OR 2.60, 95 % CI 1.85-3.64, P < 0.001) and TTH patients (OR 2.05, 95 % CI 1.41-2.98, P < 0.001). Moreover, post-IH was significantly associated with antiepileptic polytherapy (P < 0.001), high seizure frequency (P = 0.002) and tonic-clonic seizures (P = 0.043). Migraine was the most represented type of headache in patients with epilepsy. Migraineurs are more prone to develop pre-IH, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post-IH after seizures.
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TL;DR: Sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models are discussed.
Abstract: The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
50 citations
Cites background from "Headache in epilepsy: prevalence an..."
..., 2006; Rogawski, 2012); second, migraine is the most common type of headache observed in patients with epilepsy (Mainieri et al., 2015); third, the presence of comorbid migraines can negatively impact the prognosis of becoming seizurefree (Velio glu et al....
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TL;DR: In this article, the Wirksamkeit anderer Substanzen zur Prophylaxe der chronischen Migräne is not ausreichend belegt.
Abstract: • Bei chronischer Migräne mit oder ohne Übergebrauch von Schmerzoder Migränemitteln sind Topiramat und OnabotulinumtoxinA wirksam. Die Wirksamkeit anderer Substanzen zur Prophylaxe der chronischen Migräne ist nicht ausreichend belegt. • Valproinsäure, Topiramat und Amitriptylin wurden in der Migräneprophylaxe bei Kindern und Jugendlichen untersucht. Angesichts einer sehr hohen Placeborate konnte keine therapeutische Überlegenheit zu Placebo gezeigt werden. • Der Verschluss eines offenen Foramen ovale bei Migräne mit Aura führt nicht zur Attackenfreiheit.
47 citations
Cites background from "Headache in epilepsy: prevalence an..."
...Kinder, aber auch Erwachsene mit einer Epilepsie haben ebenso ein signifikant erhöhtes Risiko, an einer Migräne zu erkranken (314, 315)....
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31 Jan 2019
TL;DR: New guidelines for the treatment of migraine attacks and the prevention of migraine are established in collaboration with some of the leading headache centres in Germany, Switzerland and Austria.
Abstract: In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migrai...
44 citations
TL;DR: In this paper, the authors proposed a multidisciplinary approach to identify and eliminate possible risk and comorbidity factors for the treatment of migraine, which is designed to maintain brain homeostasis by regulating homeostatic needs such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response.
Abstract: Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.
36 citations
TL;DR: The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine.
Abstract: It is well documented that headache is a multifactorial disorder which includes not only genetic, biological, medical and neuropsychological factor but also psychological and personality traits. The close relationship between stress and migraine attacks and the significant psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction between somatic and psychological aspects in paediatric migraine. In particular in younger children, an uncomfortable situation, a psychological problem or an emotional distress is rarely expressed directly but usually through physical symptoms. So migraine may be considered as a disorder of psychobiological adaptation in which genetic predisposition interplays with internal and/or external environmental influences such as psycho-emotional, climatic, hormonal, dietary or other factors.
32 citations
Cites background from "Headache in epilepsy: prevalence an..."
...It is well known that headache in childhood is associated with several psychopathological states [56], in particular depression and anxiety [8, 9], epilepsy [67], sleep disorders [3], attention deficit hyperactivity disorder [6] which all seem to be related to headache....
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References
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5,847 citations
Northern Illinois University1, Children's Memorial Hospital2, University of Melbourne3, Western Infirmary4, Boston Children's Hospital5, UCL Institute of Child Health6, Bosch7, University of California, Los Angeles8, New York University9, Cincinnati Children's Hospital Medical Center10, Albert Einstein College of Medicine11, University of Paris12
TL;DR: The International League Against Epilepsy (ILAE) Commission on Classification and Terminology has revised concepts, terminology, and approaches for classifying seizures and forms of epilepsy.
Abstract: The International League Against Epilepsy (ILAE) Commission on Classification and Terminology has revised concepts, terminology, and approaches for classifying seizures and forms of epilepsy. Generalized and focal are redefined for seizures as occurring in and rapidly engaging bilaterally distributed networks (generalized) and within networks limited to one hemisphere and either discretely localized or more widely distributed (focal). Classification of generalized seizures is simplified. No natural classification for focal seizures exists; focal seizures should be described according to their manifestations (e. g., dyscognitive, focal motor). The concepts of generalized and focal do not apply to electroclinical syndromes. Genetic, structural-metabolic, and unknown represent modified concepts to replace idiopathic, symptomatic, and cryptogenic. Not all epilepsies are recognized as electroclinical syndromes. Organization of forms of epilepsy is first by specificity: electroclinical syndromes, nonsyndromic epilepsies with structural-metabolic causes, and epilepsies of unknown cause. Further organization within these divisions can be accomplished in a flexible manner depending on purpose. Natural classes (e. g., specific underlying cause, age at onset, associated seizure type), or pragmatic groupings (e. g., epileptic encephalopathies, self-limited electroclinical syndromes) may serve as the basis for organizing knowledge about recognized forms of epilepsy and facilitate identification of new forms.
3,775 citations
"Headache in epilepsy: prevalence an..." refers background or methods in this paper
...the 2010 International League Against Epilepsy (ILAE) Commission report [24]....
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...These cases are extremely rare, and the term is not used in the current ILAE and ICHD classification [23, 24]....
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1,674 citations
01 Jan 2005
TL;DR: In this paper, skeletal status was evaluated in 2850 females aged 7 to 77 yr using quantitative ultrasound (QUS amplitude-dependent speed of sound [Ad-SoS]), and the peak value (2121 m/s) was achieved in 19-yr-old females.
Abstract: In the study, skeletal status was evaluated in 2850 females aged 7 to 77 yr using quantitative ultrasound (QUS amplitude-dependent speed of sound [Ad-SoS]). Ad-SoS ranged from 1923 ± 30 to 1876 ± 81 m/s, and the peak value (2121 m/s) was achieved in 19-yr-old females. Ad-SoS increased significantly between subgroups aged 11 and 12 yr, 12 and 13 yr, 13 and 14 yr, 14 and 15 yr, and 15 and 16 yr. After the age of 19 yr the only significant drop was noted between age groups 47 and 48 yr. Ad-SoS was regressed on age, weight, and height for age ranges 7 to 11 yr. (before an increase in Ad-SoS), 12 to 19 yr (from the onset of the increase to the peak value), and older than 19 yr to menopause. In females after menopause, years since menopause (YSM) were taken into consideration. In the two youngest groups Ad-SoS was affected positively by age, and in the two next groups, age had a negative influence on Ad-SoS, whereas weight had a negative and height a positive influence in all groups. YSM did not influence the Ad-SoS value. It was concluded that QUS measurements at the hand phalanges are a useful tool in assessment of skeletal status in the female population.
1,020 citations
TL;DR: The proportion of both new and established cases with epilepsy in the young, adults and elderly in individual countries may differ substantially from total European distribution because of differences in age structure.
Abstract: Population-based epidemiological studies on epilepsy are available mainly from the UK and the Nordic, Baltic and western Mediterranean countries. No studies were identified from large areas of Europe, especially from the former eastern Europe (except the Baltic countries) and the eastern Mediterranean countries. Based on the prevalence of epilepsy in different studies and accounting for incomplete case identification the estimated number of children and adolescents in Europe with active epilepsy is 0.9 million (prevalence 4.5-5.0 per 1000), 1.9 million in ages 20-64 years (prevalence six per 1000) and 0.6 million in ages 65 years and older (prevalence seven per 1000). Approximately 20-30% of the epilepsy population have more than one seizure per month. Based on the age-specific incidence rates in European studies, the estimated number of new cases per year amongst European children and adolescents is 130,000 (incidence rate 70 per 100,000), 96,000 in adults 20-64 years (incidence rate 30 per 100,000) and 85,000 in the elderly 65 years and older (incidence 100 per 100,000). The proportion of both new and established cases with epilepsy in the young, adults and elderly in individual countries may differ substantially from total European distribution because of differences in age structure.
701 citations
"Headache in epilepsy: prevalence an..." refers result in this paper
...However the features of our sample resemble those of population-based epidemiological studies on epilepsy [33]....
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