Ictal epileptic headache in adult life: Electroclinical patterns and spectrum of related syndromes

Objectives: Both headache and epilepsy are frequent paroxysmal disorders that often co-occur or are related in numerous ways. Although ictal epileptic headache has become the focus of several studies, this remains a very rare and notwell-known phenomenon. Electroclinical features, pathophysiology, and syndromic context are heterogeneous. We investigated the electroclinical and neuroimaging findings in a population of adult patientswith ictal epileptic headache. Methods:We retrospectively examined 8800 EEG recordings of almost 4800 patients admitted to our video-EEG laboratory from 2010 to 2013 with a history of well-documented epilepsy. We selected patients who reported headache closely related to a seizure documented by video-EEG or 24-hour ambulatory EEG. We analyzed ictal electroclinical features of headache, and we defined the related epileptic syndromes. Results:Weidentified five patientswith ictal epileptic headache. Twopatients described tension headache during an epileptic seizure. In three patients, the headache was accompanied by other “minor” neurological symptoms mimicking amigrainous aura. In all cases, the headache stoppedwith the end of the epileptic activity. Three patients had a history of partial symptomatic epilepsy with cerebral lesions (lowgrade glioma, astrocytoma, porencephalic cyst) in the left posterior regions, whereas two patients were affected by idiopathic generalized epilepsy. Conclusion: This study confirms the rarity of ictal epileptic headache. To date, well-documented video-EEG cases remain as exceptional reports, especially in cases of idiopathic generalized epilepsies. Moreover,we confirm themain involvement of posterior regions in patientswith ictal epileptic headache affected by partial symptomatic epilepsies.