High prevalence of headaches in patients with epilepsy
TL;DR: The high prevalence of postictal headaches confirms the frequent triggering of a headache by a seizure, a condition in which the real triggering effect of the headache on the seizure might be difficult to prove.
Abstract: To examine the association between headaches and epilepsy. Consecutive adult epileptic patients who went to the outpatient clinic of the Epilepsy Center of PLA General Hospital between February 01, 2012, and May 10, 2013, were recruited into this study. A total of 1109 patients with epilepsy completed a questionnaire regarding headaches. Overall, 60.1% of the patients (male: 57.2%; female: 63.8%) reported headaches within the last year. The age-weighted prevalence of interictal migraine was 11.7% (male 8.9%, female 15.3%), which is higher than that reported in a large population-based study (8.5%, male 5.4%, female 11.6%) using the same screening questions. The prevalence of postictal headaches was 34.1% (males 32.7%, females 35.2%), and the presence of preictal headaches was 4.5% (males 4.3%, females 5.2%). The prevalence of headache yesterday in the general population was 4.8% (male 3.0%, female 6.6%). Thus, the prevalence of headaches, including migraine, is higher in epileptic patients in China. The high prevalence of postictal headaches confirms the frequent triggering of a headache by a seizure. A much lower frequency of preictal headaches, a condition in which the real triggering effect of the headache on the seizure might be difficult to prove.
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TL;DR: The pooled estimated prevalence of headache among patients with epilepsy was considerably high (48.4%) and Screening and appropriate management of headaches among Patients with epilepsy are warranted.
Abstract: Headache is the symptom of pain in the face, head or neck that causes disability in most people with medical and neurological disorders. It frequently co-occurs with most chronic diseases such as epilepsy and significantly impacts the quality of life. However, epidemiologic data from different studies showed different rates of prevalence. Therefore, we conducted this review to summarize the available epidemiologic evidence on the topic and formulate recommendations for future research and clinical practice. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. We systematically searched the literature using popular databases such as PubMed, EMBASE, Psych-INFO, and SCOPUS. We further scanned the reference lists of the eligible studies to supplement our electronic search. The Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) was used to conduct a meta-analysis. Subgroup and sensitivity analysis were performed and Cochran’s Q- and the I2- test were used to assess the source of heterogeneity. The funnel plot and Egger’s regression tests were used to assess potential publication bias. A total of 17 studies conducted both in developed and developing countries including 5564 study participants were combined in this meta-analysis. The pooled estimated prevalence of headache among patients with epilepsy was 48.4%. The pooled estimated prevalence of Inter-Ictal headache (IIH) (42.2%) and Postictal headache (PIH) (43.1%) were higher when compared to tension-type headache (TTH) (26.2%), migraine with aura (26.0%) and migraine without aura (10.4%). The pooled prevalence of headache was 50.6% and 49.5% for developed and developing countries respectively. The pooled prevalence of headache among patients with epilepsy was considerably higher among females (63.0%) when compared to males (33.3%). Moreover, the pooled estimated prevalence of headache among patients with epilepsy was ranging from 46.0% to 52.2% in a leave-one-out sensitivity analysis. The pooled estimated prevalence of headache among patients with epilepsy was considerably high (48.4%). Screening and appropriate management of headaches among patients with epilepsy are warranted.
22 citations
TL;DR: Comparisons with results of a previous meta-analysis on all RCTs in patients with drug-resistant epilepsies showed that ataxia, diplopia and fatigue were significantly more frequent, and patients withdrawing were significantly less frequent, in placebo-treated epileptic patients.
Abstract: The aim of this study was to assess the nocebo effect in all randomised controlled trials (RCTs) exploring the effect of antiepileptic drugs (AEDs) in the clinical conditions in which these compounds have been studied with the exception of epilepsy. We searched for all double-blind, placebo-controlled trials performed in adult patients, testing AEDs in any clinical condition except epilepsy. The following data were extracted from the placebo arms: the number of randomized patients, the number of patients withdrawing because of adverse effects (AEs), and the number of patients with 11 predefined AEs (dizziness, ataxia/coordination abnormal, diplopia, somnolence, fatigue, headache, memory impairment, tremor, abnormal thinking, anxiety and depression). Outcome measures were the percentages of patients whithdrawing due to AEs and reporting the selected AEs. RCTs included in the analysis were grouped in six main categories of clinical conditions (pain, movement disorders, psychiatric disorders, substance abuse, obesity and binge eating disorders, and miscellanea). Proportions of patients with 95 % confidence intervals (CIs) have been calculated for all reported outcome measures. Thirteen AEDs were studied and the total number of selected RCTs was 157. Significant percentages of placebo-treated patients withdrawing due to AEs and with specific AEs were observed in several cases. Significant differences emerged across different conditions. Comparisons with results of a previous meta-analysis on all RCTs in patients with drug-resistant epilepsies showed that ataxia, diplopia and fatigue were significantly more frequent, and patients withdrawing were significantly less frequent, in placebo-treated epileptic patients. Significant differences have been identified in the AEDs-induced nocebo effect across different conditions. Placebo-treated epilepsy patients have significantly more frequent neurological AEs.
17 citations
Cites background from "High prevalence of headaches in pat..."
...As regards headache, differences in the proportion of patients with episodes of migraine may reflect comorbidities with the condition which is intended to treat [15]....
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TL;DR: The interrelations between headache/migraine and epileptic seizures are an interesting topic, still lacking a systematization, which is the objective of the present revision and a classification is suggested which is shown in Appendix.
Abstract: The interrelations between headache/migraine and epileptic seizures are an interesting topic, still lacking a systematization, which is the objective of the present revision. We organize the general setting on: (a) a distinction between pre-ictal, ictal, post-ictal and inter-ictal headaches, assuming "ictal" as epileptic seizure, and (b) the kind of headache, if it is of migraine type or not. Concerning pre-ictal migraine/headache, the necessity of its differentiation from an epileptic headache presenting as an aura of a seizure is stressed; this is connected with the indefiniteness of the term "migralepsy". The term "migraine aura-triggered seizure" should be used only in front of a proven triggering effect of migraine. Epileptic headache (called also "ictal epileptic headache") is a well-characterized entity, in which different types of head pain may occur and an ictal EEG is necessary for the diagnosis. It may present as an isolated event ("isolated epileptic headache"), requiring a differential diagnosis from other kinds of headache, or it may be uninterruptedly followed by other epileptic manifestations being in this case easily identifiable as an epileptic aura. Hemicrania epileptica is a very rare variant of epileptic headache, characterized by the ipsilaterality of head pain and EEG paroxysms. Ictal non-epileptic headache needs to be differentiated from epileptic headache. Post-ictal headaches are a frequent association of headache with seizures, particularly in patients suffering also from inter-ictal headache-migraine. The reported systematization of the topic led us to suggest a classification which is shown in Appendix.
16 citations
Cites background from "High prevalence of headaches in pat..."
...ache, and particularly migraine, in patients with epilepsy, compared to the general population, appears to be more frequent until the fourth decade, but not in older ages, according to [32]....
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TL;DR: Results show that investigating and controlling headaches may relieve affective symptoms and ultimately improve the quality of life of PWE.
13 citations
TL;DR: The prevalence of headache and the prevalence of migraine, which are considered to be pathogenetically linked to epilepsy, were not different in epilepsy patients as compared to that of the general population.
Abstract: Similar clinical characteristics of epilepsy and migraine and the prevalence of their comorbidity have been investigated for years The present study investigated the relationship between epilepsy and headache A total of 420 epilepsy patients, who visited epilepsy outpatient clinic within 6-month period between January 2016 and June 2016, were questioned whether they have headache Age, gender, duration of epilepsy, type of seizures, and temporal relationship of headache with seizure were investigated in the patients with headache Headache was detected in 111 (26%) of 420 epilepsy patients The prevalence of migraine was 15% When the temporal relationship of headache with seizure was evaluated, interictal headache was found to be the most common type with a percentage of 748% No significant difference was determined between the patients with migraine and non-migraine headache in terms of age, gender, duration of epilepsy, age at the onset of epilepsy, type of seizure, and electroencephalography findings The prevalence of interictal headache was statistically significantly higher in migraine patients as compared to that of non-migraine patients (p < 0001); however, the prevalence of preictal headache and the prevalence of postictal headache were significantly lower (p = 0001 and p < 0001, respectively) The prevalence of headache and the prevalence of migraine, which are considered to be pathogenetically linked to epilepsy, were not different in epilepsy patients as compared to that of the general population Different outcomes and percentages in other studies suggest that pathogenesis of headache is multifactorial and that different diagnostic criteria might have been taken into consideration
12 citations
Cites background or result from "High prevalence of headaches in pat..."
...[17] performed a study in China and determined higher rates of headache (57....
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...In the same study, a correlation was determined between the frequency and the type of seizures and the prevalence of headache, and it was reported that postictal headache is more common in those suffering from generalized seizure with interictal migraine being more prevalent than the normal population [17]....
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...[17] found that the annual prevalence of headache in the interictal period is higher as compared to the general population....
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...Although the frequencies of migraine in headaches having temporal relationship with seizure and in preictal headaches have been reported differently in different studies, the frequency of postictal headache has been determined higher in many studies [14, 17, 21]....
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...In the same study, no relationship was found between epileptic syndrome, epileptic focus, and the topography of headache [17]....
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References
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5,847 citations
TL;DR: The calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine, which would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
Abstract: This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
2,067 citations
"High prevalence of headaches in pat..." refers background in this paper
...Primary headache disorders, particularly migraine and tension-type headache (TTH), are globally prevalent [1-5]....
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1,674 citations
TL;DR: The magnitude and distribution of the public health problem posed by migraine in the United States is described by examining migraine prevalence, attack frequency, and attack-related disability by gender, age, race, household income, geographic region, and urban vs rural residence.
Abstract: Objective. —To describe the magnitude and distribution of the public health problem posed by migraine in the United States by examining migraine prevalence, attack frequency, and attack-related disability by gender, age, race, household income, geographic region, and urban vs rural residence. Design. —In 1989, a self-administered questionnaire was sent to a sample of 15000 households. A designated member of each household initially responded to the questionnaire. Each household member with severe headache was asked to respond to detailed questions about symptoms, frequency, and severity of headaches. Setting. —A sample of households selected from a panel to be representative of the US population in terms of age, gender, household size, and geographic area. Participants. —After a single mailing, 20468 subjects (63.4% response rate) between 12 and 80 years of age responded to the survey. Respondents and non-respondents did not differ by gender, household income, region of the country, or urban vs rural status. Whites and the elderly were more likely to respond. Migraine headache cases were identified on the basis of reported symptoms using established diagnostic criteria. Results. —17.6% of females and 5.7% of males were found to have one or more migraine headaches per year. The prevalence of migraine varied considerably by age and was highest in both men and women between the ages of 35 to 45 years. Migraine prevalence was strongly associated with household income; prevalence in the lowest income group ( Conclusions. —A projection to the US population suggests that 8.7 million females and 2.6 million males suffer from migraine headache with moderate to severe disability. Of these, 3.4 million females and 1.1 million males experience one or more attacks per month. Females between ages 30 to 49 years from lower-income households are at especially high risk of having migraines and are more likely than other groups to use emergency care services for their acute condition. (JAMA. 1992;267:64-69)
1,576 citations
"High prevalence of headaches in pat..." refers background in this paper
...Primary headache disorders, particularly migraine and tension-type headache (TTH), are globally prevalent [1-5]....
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TL;DR: The study supports the notion that migraine and tension-type headache are separate clinical entities and that migraine without aura and migraine with aura are distinct subforms of migraine.
Abstract: Headache disorders constitute a public-health problem of enormous proportions, with an impact on both the individual sufferer and society. Epidemiological knowledge is required to quantitate the significance of these disorders. The effects on individuals can be assessed by examining prevalence, distribution, attack frequency and duration, and headache-related disability. The socio-economic burden includes both direct costs associated with health care utilization and costs associated with missed work due to sickness absence or reduced efficiency. The individual and socio-economic burden of headaches is substantial. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis and treatment.
695 citations