Fanella Martina, Morano Alessandra, Fattouch Jinane, Albini Mariarita, Manfredi Mario, Giallonardo Anna Teresa, Di Bonaventura Carlo
Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
Department of Neurology and Psychiatry, Neurology Unit, "Sapienza" University, Rome, Italy.
Epilepsy Behav. 2015 Dec;53:161-5. doi: 10.1016/j.yebeh.2015.10.018. Epub 2015 Nov 12.
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 not well-known phenomenon. Electroclinical features, pathophysiology, and syndromic context are heterogeneous. We investigated the electroclinical and neuroimaging findings in a population of adult patients with ictal epileptic headache.
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.
We identified five patients with ictal epileptic headache. Two patients described tension headache during an epileptic seizure. In three patients, the headache was accompanied by other "minor" neurological symptoms mimicking a migrainous aura. In all cases, the headache stopped with the end of the epileptic activity. Three patients had a history of partial symptomatic epilepsy with cerebral lesions (low grade glioma, astrocytoma, porencephalic cyst) in the left posterior regions, whereas two patients were affected by idiopathic generalized epilepsy.
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 the main involvement of posterior regions in patients with ictal epileptic headache affected by partial symptomatic epilepsies.
头痛和癫痫均为常见的发作性疾病，常同时出现或以多种方式相关联。尽管发作期癫痫性头痛已成为多项研究的焦点，但这仍是一种非常罕见且鲜为人知的现象。其电临床特征、病理生理学及综合征背景具有异质性。我们调查了成年发作期癫痫性头痛患者的电临床和神经影像学表现。
我们回顾性检查了2010年至2013年入住我们视频脑电图实验室的近4800例有明确癫痫病史患者的8800份脑电图记录。我们选择了报告头痛与视频脑电图或24小时动态脑电图记录的发作密切相关的患者。我们分析了头痛的发作期电临床特征，并确定了相关的癫痫综合征。
我们识别出5例发作期癫痫性头痛患者。2例患者描述在癫痫发作期间出现紧张性头痛。在3例患者中，头痛伴有其他类似偏头痛先兆的“轻微”神经症状。在所有病例中，头痛随着癫痫活动的结束而停止。3例患者有左侧后部区域的部分症状性癫痫伴脑损伤（低度胶质瘤、星形细胞瘤、脑穿通囊肿）病史，而2例患者患有特发性全身性癫痫。
本研究证实了发作期癫痫性头痛的罕见性。迄今为止，有充分记录的视频脑电图病例仍然是例外报告，尤其是在特发性全身性癫痫病例中。此外，我们证实了发作期癫痫性头痛且患有部分症状性癫痫的患者主要累及后部区域。
