May 4, 2021

Treatment of Postictal Headache: A Systematic Review and Future Directions

Abstract, originally published in Epilepsy & Behavior

Background: Postictal headache (PIH; headache after a seizure) is a common complaint among patients with epilepsy. The prevalence of PIH is 43%. In the current endeavor, we systematically reviewed the existing treatment options for PIH in order to depict the state of the field and also to propose a research agenda to advance this topic.

Methods: MEDLINE, Scopus, and Embase from the inception to 4 February, 2021 were systematically searched for related published articles. In all electronic databases, the following search strategy was implemented and these key words (in all fields) were used: “post-ictal” AND “Headache” AND “Treatment”.

Results: The primary search yielded 626 studies; only five studies were related to the topic and were included in the current systematic review. None of these studies provided a good class of evidence. These studies suggested that flunarizine and sumatriptan may help patients with PIH.

Conclusion: While postictal headache is a common and disabling condition, its treatment is overlooked by the epilepsy society. Flunarizine and sumatriptan can be good candidates to be used in future clinical trials of the treatment of postictal headache. To obtain the desired evidence on the efficacy of either flunarizine or sumatriptan in treating postictal headache in patients with epilepsy, we need well-designed, randomized controlled trials.

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