Seizure-associated headache in epilepsy

Purpose: Headache is often ignored as a symptom of epileptic seizures. The purpose of this prospective study was to analyze frequency, classification, and characteristics of seizure-associated headache (SH) according to the c riteria of the International Headache Society. Methods: Over a period of 15 months, 341 patients with epilepsy, consecutiv ely evaluated at our outpatient clinic for SH, completed a standardized que stionnaire. Results: Of the 341 epilepsy patients, 115 (34%) experienced SH with a pain intensity of 6.1 +/- 1.6 (SD) on the visual analogue scale and a duration of 12.8 +/- 15.7 (SD) h. Seizures were always accompanied by headache in 69 (60%) of these 115 patients. SH occurred in four (3%) of 115 patients only preictally, in 31 (27%) of 115 patients periictally, and in 80 (70%) of 11 5 patients only postictally. In the majority of the 115 patients (55.7%), S H could be classified as migraine headache, whereas in 36.5%, as tension-ty pe headache. The type of SH was not correlated with sex, an epilepsy syndro me, or a seizure type. Migraine-like SH was significantly associated with a history of migraine (p < 0.001). In 20 (77%) of the 26 patients experienci ng migraine-like SH with a history of migraine, the phenomenology of migrai ne-like SH and migraine attacks was identical. Conclusions: SH is a frequent, long-lasting, and severe symptom of epilepti c seizures, causing major impairment of daily living. A history of migraine significantly increases the risk for developing migraine-like SH.