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Journal ArticleDOI

High prevalence of headaches in patients with epilepsy

04 Nov 2014-Journal of Headache and Pain (Springer Milan)-Vol. 15, Iss: 1, pp 70-70
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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Citations
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Journal ArticleDOI
TL;DR: This study examined which 5-HT receptor subtypes can be targeted to trigger antiseizure effects in homozygous scn1Lab(-/-) mutant zebrafish larvae that recapitulate DS well and confirmed the efficacy of fenfluramine as an antiepileptiform compound in zebra fish models of DS.
Abstract: Dravet syndrome (DS) is a severe epilepsy syndrome that starts within the first year of life. In a clinical study, add-on treatment with fenfluramine, a potent 5-hydroxytryptamine (5-HT) releaser activating multiple 5-HT receptor subtypes, made 70% of DS children seizure free. Others and we recently confirmed the efficacy of fenfluramine as an antiepileptiform compound in zebrafish models of DS. By using a large set of subtype selective agonists, in this study we examined which 5-HT receptor subtypes can be targeted to trigger antiseizure effects in homozygous scn1Lab–/– mutant zebrafish larvae that recapitulate DS well. We also provide evidence that zebrafish larvae express the orthologues of all human 5-HT receptor subtypes. Using an automated larval locomotor behavior assay, we were able to show that selective 5-HT1D-, 5-HT1E-, 5-HT2A-, 5-HT2C-, and 5-HT7-agonists significantly decreased epileptiform activity in the mutant zebrafish at 7 days post fertilization (dpf). By measuring local field potential...

89 citations

Journal ArticleDOI
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.

46 citations


Cites background or result from "High prevalence of headaches in pat..."

  • ...Pre-IH, usually with migrainous features, was reported in 6 % of our population and only in patients with interictal migraine, in line with previous studies [14, 16, 18, 21, 25]....

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  • ...2014 [21] 1109 607/502 ≥18 Self-administered questionnaire + standardized semi-structured telephone interview 12....

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  • ...As a mild condition in spite of seizure disorder, TTH could be underestimated in patients with epilepsy [11, 12, 14, 17, 18, 20, 21]....

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Journal ArticleDOI
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

Journal ArticleDOI
TL;DR: It is suggested that headaches, particularly migraine-type headaches, were frequently experienced by patients with epilepsy, postictal headaches were more common, and the frequency of migraine attacks could be linked with seizure frequency and the type of treatment.

25 citations


Cites background from "High prevalence of headaches in pat..."

  • ...6–96% for postictal headaches following generalized tonic-clonic seizures [21,22, 25,33]....

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Journal ArticleDOI
TL;DR: Prodromes are characterized by a broad spectrum of preictal symptoms that may be experienced for a duration of between 10min and several days, which usually persist until seizure onset, and usually persist for between 30min and 24h.

23 citations

References
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Journal ArticleDOI
TL;DR: This picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them.
Abstract: In order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache. Throughout China, 5,041 unrelated respondents aged 18–65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year. Significantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on ≥15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6–7.4; moderate vs. minimal: 2.5, 1.2–5.4; severe vs. minimal: 3.9, 1.9–8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9–6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07–0.93; P = 0.038). About half of consultations (47.8–56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on ≥15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on ≥15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with “nervous headache” as with migraine. “Nervous headache” (9.8%) and “vascular headache” (7.6%) were the most likely diagnoses in those with TTH, of whom only 5.6% had previously been correctly diagnosed. These were also the most likely diagnoses (14.0% each) in consulters with headache on ≥15 days/month. This picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them. This is not a picture of an efficient or cost-effective response to major causes of public ill-health and disability.

109 citations

Journal ArticleDOI
TL;DR: Based on the current knowledge, migralepsy is highly unlikely to exist as such and the term is proposed to be deleted until clear evidence its existence is provided, followed by a revision of terminology and classification criteria to properly represent the migraine/headache relationships.
Abstract: Despite the fact that migraine and epilepsy are among the commoner brain diseases and that comorbidity of these conditions is well known, only few reports of migralepsy and hemicrania epileptica (HE) have been published according to the current ICHD-II criteria. Particularly, ICHD-II describes “migraine-triggered seizure” (i.e., migralepsy) among complications of migraine at “1.5.5” (as a rare event in which a seizure happens during migrainous aura), while hemicrania epileptica (coded at “7.6.1”) and post-ictal headache (coded at “7.6.2”) are described among headaches attributed to epileptic seizure. However, to date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may be the sole ictal epileptic manifestation. Based on the current knowledge, migralepsy is highly unlikely to exist as such. We, therefore, propose to delete this term until clear evidence its existence is provided. Moreover, we herein propose a revision of terminology and classification criteria to properly represent the migraine/headache relationships. We suggest the term “ictal epileptic headache” in cases in which headache/migraine is the sole ictal epileptic manifestation.

101 citations


"High prevalence of headaches in pat..." refers background in this paper

  • ...An association between migraine and epilepsy has been demonstrated in several studies [11,12], but the data are complicated, and the studies have been limited by small numbers....

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Journal ArticleDOI
TL;DR: It is proposed that post-epileptic headache arises intracranially and is related to the vasodilatation known to follow seizures, and is discussed in the light of current ideas on migraine pathogenesis, in particular the Vasodilation which accompanies Leao's spreading cortical depression.
Abstract: One hundred epileptic patients were questioned about their headaches. Post-ictal headaches occurred in 51 of these patients and most commonly lasted 6-72 hours. Major seizures were more often associated with post-epileptic headaches than minor attacks. Nine patients in this series of 100 also had migraine: in eight of these nine a typical, albeit a mild, migraine attack was provoked by fits. The post-ictal headache in the 40 epileptics who did not have migraine was accompanied by vomiting in 11 cases, photophobia in 14 cases and vomiting with photophobia in 4 cases. Furthermore, post-epileptic headache was accentuated by coughing, bending and sudden head movements and relieved by sleep. It is, therefore, clear that seizures provoke a syndrome similar to the headache phase of migraine in 50% of epileptics. It is proposed that post-epileptic headache arises intracranially and is related to the vasodilatation known to follow seizures. The relationship of post-epileptic headache to migraine is discussed in the light of current ideas on migraine pathogenesis, in particular the vasodilation which accompanies Leao's spreading cortical depression.

92 citations

Journal ArticleDOI
TL;DR: The International Classification of Headache Disorders (ICHD-2) committee recognizes three nosographic entities concerning the relationship between epilepsy and headache and the International League Against Epilepsy classification fully recognizes these entities.
Abstract: Dear Sir, More frequently associated than expected on the basis of coincidence, headache and epilepsy are both characterized by transient paroxysmal episodes of altered brain function with clinical, pathophysiological and therapeutic overlap. Cortical spreading depression (CSD) is probably the connection point between these two conditions. In fact, CSD and an epileptic focus are able to facilitate each other (1–3), and in the central nervous system there is a hierarchical organization based on ‘neuronal networks’ (cortical and subcortical) which may be more or less prone to CSD (migraine) and/or an epileptic focal discharge (i.e. seizures). Hyperexcitation occurs in epilepsy, in migraine hypoexcitation followed by hyperexcitation, as rebound phenomenon (spreading depression) (1–3). Moreover, a disexcitability condition (hyperand hypoexcitation in the same patient at different points in time) has even been demonstrated (1–3). The International Classification of Headache Disorders (ICHD-2) committee recognizes three nosographic entities concerning the relationship between epilepsy and headache (Table 1). The International League Against Epilepsy (ILAE) classification fully

88 citations


"High prevalence of headaches in pat..." refers background in this paper

  • ...We did not include an EEG recording of the periictal phase, so we cannot “demonstrate or rule out" if periictal cases could be an "epileptic headache" (cases where headache can be the sole ictal epileptic manifestation) [37]....

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Journal ArticleDOI
TL;DR: This large-scale study characterized HA types and head sensations in large populations of individuals with well‐defined forms of epilepsy and found associations between headache and epilepsy is well known.
Abstract: Summary: Purpose: The association between headache (HA) and epilepsy is well known. However, few previous studies characterized HA types and head sensations (HSens) in large populations of individuals with well-defined forms of epilepsy. Methods: To analyze the incidence of HA in such a group, we compare HA and non-HA patients to identify special predictive factors for HAs or migraine. We also investigate the pathologically verified group for possible correlations with HAs or migraine. One hundred consecutive patients undergoing presurgical evaluation for pharmacologically intractable partial epilepsy were interviewed. For each HA type, we inquired about lateralization, localization, quality of HA, and results of treatment. Results: Periictal HAs were reported by 47 patients. Of those, 11 had preictal HA (PIHA), and 44 had postictal HA (PostHA). Eight patients had both PIHA and PostHA. Interictal HAs (InterHAs) were reported by 31 patients. Twenty-nine (62%) of 47 patients had frontotemporal HAs. Twenty-five patients had migraine-like HA without aura: 18 (60%) of 30 patients with temporal lobe epilepsy (TLE) and seven (41%) of 17 with extratemporal epilepsy (ETE). No correlation between pathology and presence of HA was found in 59 pathologically verified patients, except in four who had arteriovenous malformations (AVMs): three had and one did not have HAs. Eighteen patients had, in addition, poorly localized and ill-described HSens other than HAs. Conclusions: We confirm an association between focal epilepsy and HAs, including migraine without aura. This is true for both TLE and ETE. PIHA and even prodromal HA may be related to the epileptic discharge and may have lateralizing value. This association is not recognized by the current International Headache Society (IHS) classification. The presence of HA and migraine is not related to the underlying epileptogenic pathology except in patients with AVMs.

73 citations


"High prevalence of headaches in pat..." refers result in this paper

  • ...Similar findings have been reported by others [35,36]....

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