Multi-center study on migraine and seizure-related headache in patients with epilepsy
Kyoung Heo1, Byung In Lee1, Kyoon Huh2, Hyunwoo Nam3, Ok Joon Kim, Young Min Shon4, Ha-Young Choi5, Myeong Kyu Kim6, Hoo Won Kim7, Sung Hyun Lee, Jae Moon Kim8, Ji-Eun Kim9, Tae Wan Kim, Jangjoon Lee, Sang Bong Lee4, Sang-Ho Kim10, Byung Kun Kim11, Gun Sei Oh11, Hyang Woon Lee, Dong Jin Shin12, Hyeon-Mi Park12, Juhan Kim13, Sung Eun Kim14, Jeong Yeon Kim14, Pil-Wook Chung15, Hong Ki Song16, Sang Do Yi17, Yong Won Cho17, Jin Yong Choi18, Hyun Jeong Han19, Jun Hong Lee20, Sang Kun Lee3, Kwang Ik Yang, Hyun Park21, Se Jin Lee22, Won Joo Kim1 •
Yonsei University1, Ajou University2, Seoul National University3, Catholic University of Korea4, Chonbuk National University5, Chonnam National University6, Chosun University7, Chungnam National University8, Catholic University of Daegu9, Dong-a University10, Eulji University11, Gachon University12, Hanyang University13, Inje University14, Samsung15, Sacred Heart Hospital16, Keimyung University17, Konkuk University18, Kwandong University19, Dongguk University20, Wonkwang University21, Yeungnam University22
01 Mar 2010-Yonsei Medical Journal (Yonsei University College of Medicine)-Vol. 51, Iss: 2, pp 219-224
TL;DR: It is suggested that SRH is a frequent accompanying symptom of epileptic seizures causing major impairment in daily life, and migraine is an important comorbidity of epilepsy, affecting the incidence and characteristics of SRH.
Abstract: Purpose The purpose of this study is to investigate the frequency and characteristics of migraine and seizure-related headache (SRH) according to the criteria of the International Headache Society. Materials and Methods A questionnaire was undertaken at the initial evaluation of newly referred patients from 32 epilepsy clinics. Results Of a total of 597 patients, 74 (12.4%) patients had migraine. Age at the onset of epilepsy was lower in patients with migraine than in those without. Twenty-six (4.4%), nine (1.5%), and 146 (24.5%) patients experienced prodromal, ictal, and postictal SRH, respectively (n = 169, 28.3%). A pain intensity of prodromal and postictal SRH was 6.1 ± 1.5 (SD) and 6.3 ± 1.9 (SD) on the visual analogue scale, and their duration was 12.6 ± 26.7 (SD) hours and 9.0 ± 17.4 (SD) hours, respectively. Age at the onset of epilepsy was lower in patients with SRH than in those without, and the risk of occurrence of SRH was significantly greater in patients with longer epilepsy duration. SRH could be classified as a type of migraine in 46.2% of patients with prodromal SRH and in 36.3% of patients with postictal SRH. Prodromal SRH occurred more frequently and was more likely to be a migraine-type in patients with migraine compared with those without. Postictal SRH occurred more frequently and was more likely to be a migraine-type in patients with migraine. Conclusion This study suggests that SRH is a frequent accompanying symptom of epileptic seizures causing major impairment in daily life, and migraine is an important comorbidity of epilepsy, affecting the incidence and characteristics of SRH.
Citations
More filters
••
TL;DR: An extensive review of the literature is performed and definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures are suggested.
Abstract: Purpose There are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure ("migralepsy"), 2. hemicrania epileptica, and 3. post-ictal headache. Methods We performed an extensive review of the literature, not including "post-ictal" and "inter-ictal" headaches. Results On the basis of well-documented reports, the following clinical entities may be identified: (A) "epileptic headache (EH)" or "ictal epileptic headache (IEH)": in this condition headache (with or without migrainous features) is an epileptic manifestation per se , with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from "pure" or "isolated" EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). "Hemicrania epileptica" (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) "Pre-ictal migraine" and "pre-ictal headache": when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role ("migraine-triggered seizure") is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term "migralepsy" has not been used uniformly, and may therefore led to misinterpretation. Conclusions On the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures.
60 citations
••
Greta Mainieri1, Greta Mainieri2, S. Cevoli2, Giulia Giannini1, Giulia Giannini2, L. Zummo1, L. Zummo3, L. Zummo2, Chiara Leta1, Chiara Leta2, M. Broli1, M. Broli2, Lorenzo Ferri1, Lorenzo Ferri2, Margherita Santucci1, Margherita Santucci2, Annio Posar1, Annio Posar2, Patrizia Avoni2, Patrizia Avoni1, Pietro Cortelli1, Pietro Cortelli2, Paolo Tinuper1, Paolo Tinuper2, Francesca Bisulli2, Francesca Bisulli1 •
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
••
TL;DR: Although the incidence of headache in epilepsy patients appeared to be low, it was underdiagnosed and associated with substantial negative impact and took over‐the‐counter analgesics as acute treatment.
Abstract: High prevalence of headache has been reported in patients with refractory epilepsy in cross-sectional surveys based on retrospective recall We conducted a prospective study to document the incidence of headache over a 3-month observation period in a cohort of 227 adult patients with less refractory epilepsy The mean seizure frequency was 246 per month Fifty (22%) patients reported to have had at least one headache episode, 45 (198%) had interictal headache, 11 (48%) had periictal headache, and 5 (22%) had both interictal and periictal headache Forty-nine percent of the patients with headache took over-the-counter analgesics as acute treatment The headache was rated to have made very severe or substantial impact on their lives by 34% of patients A formal headache diagnosis was not made in any of the patients prior to the survey Although the incidence of headache in epilepsy patients appeared to be low, it was underdiagnosed and associated with substantial negative impact
44 citations
Cites methods from "Multi-center study on migraine and ..."
...In addition, each patient completed the Headache Impact Test (HIT-6) to assess the degree of headache-related disability (Kosinski et al., 2003)....
[...]
••
TL;DR: The association between partial epilepsy and migraine without aura is most common and reported in 82% of the authors' patients with peri-ictal headache and in 76.5% of patients with post-ictsal headache.
Abstract: Headache in epileptic population ranges from 8% to 15%. The aim of this paper was to study the clinical and temporal characteristics of primary headache comorbidity in idiopathic epileptic children. From June 2006 to June 2009, a cross-sectional multi-center study involving five Italian Child Neurology University Centers (two in Rome, one in Chieti, one in Naples, and one in L'Aquila) was conducted. Among 1,264 consecutively newly diagnosed, idiopathic, partial, or generalized, epileptic children, according to ILAE diagnostic criteria (aged between 5 and 15 years of age), we selected 142 children (11.2%) (130 of whom completed the study) who showed an associated peri-ictal and/or inter-ictal headache diagnosed according to the International Headache Society Criteria. Rare cases of “ictal epileptic headache”, in which headache represents the sole ictal epileptic manifestation, were excluded from this study. Post-ictal headaches were most frequent (62%). Pre-ictal headaches were less common (30%). Inter-ictal headaches were described in 57.6%. Clear migrainous features were present in 93% of pre-ictal and 81.4% of post-ictal headaches. Inter-ictal headaches meet criteria for migraines in 87%. The association between partial epilepsy and migraine without aura is most common and reported in 82% of our patients with peri-ictal headache and in 76.5% of patients with post-ictal headache.
43 citations
••
TL;DR: The connection between headache and epilepsy in various aspects is discussed, including classification, clinical features, epidemiology, genetics, pathophysiology, and treatment.
Abstract: Headache, especially migraine, has long been associated with epilepsy, based on the common clinical features of these disorders. Both migraine and epilepsy have a genetic predisposition and share common pathophysiological mechanisms including an imbalance between excitatory and inhibitory factors that result in spells of altered brain function and autonomic symptoms. There are well-documented reports on the headache as a sole manifestation of epileptic seizure and headache is commonly associated with as preictal, ictal, and postictal symptoms in epilepsy patients. In addition, migraine and epilepsy are frequently described as highly comorbid conditions and several antiepileptic drugs are used for the patients with migraine as well as epilepsy. In the present review, we briefly discuss the connection between headache and epilepsy in various aspects, including classification, clinical features, epidemiology, genetics, pathophysiology, and treatment.
42 citations
Cites background from "Multi-center study on migraine and ..."
...3% of patients with postictal seizure-related headache.(13) The incidence of headache in more than 800 patients with refractory epilepsy with video-EEG conformation as an aura, preictal and postictal headache in Korea was 0....
[...]
...5%).(13,26) However, the prevalence of migraine in epilepsy patients in that study (12....
[...]
References
More filters
••
5,847 citations
••
1,674 citations
••
TL;DR: A simple model for migraine attacks is suggested: A pathological disturbance in one cerebral hemisphere causes the aura symptoms and after a time delay, it also causes the headache by stimulating local vascular nociceptors.
Abstract: Ten years of study has resulted in considerable but fragmented knowledge about regional cerebral blood flow in migraine with aura (classic migraine). In the present study, the number of repeatedly studied patients (n = 63) was large enough to determine statistically significant sequences of events and statistically significant spatial relations. The first observable event was a decrease of regional cerebral blood flow posteriorly in one cerebral hemisphere. Further development of this pathological process was accompanied by the aura symptoms. Thereafter headache occurred while regional cerebral blood flow remained decreased. During the headache phase, regional cerebral blood flow gradually changed from abnormally low to abnormally high without apparent change in headache. In some patients headache disappeared while regional cerebral blood flow remained increased. Although regional cerebral blood flow reduction and aura symptoms in the great majority of patients were unilateral, one-third had bilateral headache. Unilateral headache usually localized to the side on which regional cerebral blood flow was reduced and from which the aura symptoms originated (i.e., aura symptoms were perceived to occur contralaterally but presumably originated in the hypoperfused hemisphere). Our results suggest a simple model for migraine attacks: A pathological disturbance in one cerebral hemisphere causes the aura symptoms and after a time delay, it also causes the headache by stimulating local vascular nociceptors. Bilateral headache caused by a unilateral cerebral disturbance may be explained by recent neuroanatomical and neurophysiological findings.
552 citations
••
TL;DR: The results indicate that migraine and epilepsy are strongly associated, independent of seizure type, etiology, age at onset, or family history of epilepsy.
Abstract: We investigated comorbidity of migraine and epilepsy by using information from structured telephone interviews with 1,948 adult probands with epilepsy and 1,411 of their parents and siblings. Epilepsy was defined as a lifetime history of two or more unprovoked seizures, and migraine as severe headaches with two or more of the following symptoms: unilateral pain, throbbing pain, visual aura, or nausea. Cumulative incidence of migraine to age 40 was 24% in probands with epilepsy, 23% in relatives with epilepsy, and 12% in relatives without epilepsy. Using Cox proportional hazards analysis to control for years at risk and gender, the rate ratio for migraine was 2.4 (95% CI, 2.02 to 2.89) among probands and 2.4 (1.58 to 3.79) among relatives with epilepsy in comparison with relatives without epilepsy. Migraine risk was highest in probands with epilepsy due to head trauma, but it was significantly higher in every subgroup of probands than in unaffected relatives when probands were stratified by seizure type, age at onset, etiology of epilepsy, and history of epilepsy in first-degree relatives. Age-specific incidence of migraine among probands was increased to a greater extent after onset of epilepsy than before, but it was also significantly increased more than 5 years before onset and 1 to 5 years before onset. These results indicate that migraine and epilepsy are strongly associated, independent of seizure type, etiology, age at onset, or family history of epilepsy.
306 citations
••
TL;DR: There was improved seizure control with combination antimigraine and antiepileptic drugs (AEDs) in six patients who failed to respond to AEDs alone and in two patients, the entire sequence from migraine aura to partial seizure was recorded.
Abstract: We studied the relationship between migraine and epilepsy in 395 adult seizure patients. Seventy-nine patients (20%) also had migraine syndrome, and 13 of these patients (3%) experienced seizures during or immediately following a migraine aura. Patients with catamenial epilepsy and patients with migraine with aura were at an increased risk for an association between these two disorders. In two patients, we recorded the entire sequence from migraine aura to partial seizure, and in both there were distinctive changes on the EEG during the migraine aura that preceded the onset of an electrographic complex partial seizure. Periodic lateralized epileptiform discharges were recorded in five other patients in close temporal relation to their migraine attacks. There was improved seizure control with combination antimigraine and antiepileptic drugs (AEDs) in six patients who failed to respond to AEDs alone.
151 citations