1 Department of Clinical Neurophysiology, King's College Hospital, London, UK.
2 Department of Neurosciences and Mental Health, Neurology Service, Centro Hospitalar Lisboa Norte, Lisbon, Portugal & Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Cephalalgia. 2019 Aug;39(9):1195-1199. doi: 10.1177/0333102419839792. Epub 2019 Mar 16.
Ictal epileptic headache is a rare form of painful seizure, habitually consisting of migrainous or tension-type headache. We describe a case of a patient with short-lasting, severe retroorbital pain attacks caused by frontal lobe epilepsy.
A 25-year-old male patient presented with recurrent attacks of paroxysmal, short-lasting, excruciating left periorbital and facial pain mainly occurring from sleep. After intracranial EEG exploration and resection of a right prefrontal focal cortical dysplasia, long-term seizure and headache remission was obtained.
Our case extends the clinical and neuroanatomical spectrum of ictal epileptic headache and suggests that long-term remission can be obtained by resective epilepsy surgery. It also reinforces the role of the prefrontal cortex in the pain matrix and pain generation.
Despite its rarity, ictal epileptic headache should be suspected in selected patients, particularly those with other ictal symptoms and signs, history of epileptic seizures, or neuroimaging abnormalities.
癫痫性头痛是一种罕见的痛性癫痫发作形式，通常为偏头痛或紧张型头痛。我们描述了一例由额叶癫痫引起的短暂性、剧烈眶后疼痛发作的患者。
一名 25 岁男性患者反复发作阵发性、短暂、剧烈的左侧眶周和面部疼痛，主要发生在睡眠中。行颅内脑电图检查后，对右额前叶局灶性皮质发育不良进行了切除，患者获得了长期的癫痫发作和头痛缓解。
我们的病例扩展了癫痫性头痛的临床和神经解剖范围，并提示通过切除性癫痫手术可以获得长期缓解。这也进一步证实了前额叶皮质在疼痛矩阵和疼痛产生中的作用。
尽管罕见，但对于有其他癫痫发作症状和体征、癫痫发作病史或神经影像学异常的特定患者，应怀疑为癫痫性头痛。
