October 16, 2019

Study Suggests Headache Management is Often Overlooked in the Epilepsy Population

Objective: To assess the frequency and characteristics of inter?ictal and post?ictal headaches (using International Classification of Headache Disorders, 3rd edition criteria) in a population of patients with epilepsy admitted to the Mayo Clinic Rochester epilepsy monitoring unit and assess their localizing value.

Methods: This was a cross?sectional study. Participants were voluntarily recruited upon admission to the epilepsy monitoring unit. Two separate questionnaires were then administered. The first was to assess the presence and character of headaches experienced in the past 12 months. The second was to assess characteristics of post?ictal headaches experienced during their admission including localization.

Results: One hundred and twenty subjects (77%) met inclusion criteria and completed the initial questionnaire. Mean age was 38.1 years (range 18?82), 67 (55.8%) were female. Inter?ictal headaches were reported in 97 of 120 (81%) subjects, these met ICHD3 criteria for migraine in 48 (50%). Postictal headaches were reported by 75 of 120 (63%) subjects on the initial admission questionnaire, representing migraine in 38 (51%). Thirty nine (32%) subjects completed the secondary questionnaire related to post?ictal headaches experienced during admission, of which nine (23%) met criteria for migraine. There was no seizure lateralizing or localizing value noted based on post?ictal headache localization.

Significance: Migraine was frequent in this cohort, and appears to be the dominant inter?ictal and post?ictal headache type in patients with epilepsy. In this study, the first to assess incident post?ictal headache in the setting of an ictal EEG, headache localization was of no seizure localizing value. Few patients were being actively treated; suggesting headache management is often overlooked in the epilepsy population.

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