Demarquay Geneviève, Sala Emilie, Adham Ahmed, Camdessanché Jean-Philippe, Convers Philippe, Mazzola Laure
Department of Neurology, Hospices Civils de Lyon, University of Lyon, Lyon, France.
NeuroPain Lab, INSERM U1028, UMR5292, Lyon Neuroscience Research Center, CNRS, University Claude Bernard Lyon 1, Lyon, France.
Headache. 2023 Mar;63(3):455-458. doi: 10.1111/head.14475. Epub 2023 Mar 10.
Ictal epileptic headache (IEH) is caused by a focal epileptic seizure. The diagnosis can be challenging when the headache is isolated without any other symptoms.
A 16-year-old girl presented with a 5-year history of bilateral frontotemporal headaches with severe intensity lasting for 1-3 min. Past medical, physical, and developmental histories were unremarkable. Head magnetic resonance imaging showed right hippocampal sclerosis. The diagnosis of pure IEH was confirmed by video-electroencephalographic monitoring. The onset and cessation of frontal headache correlated with a right temporal discharge. The patient was diagnosed with right mesial temporal lobe epilepsy. Two years later, her seizures increased despite antiseizure medications. A right anterior temporal lobectomy was performed. The patient remained seizure-free and headache-free for 10 years.
IEH should be considered in the differential diagnosis of brief and isolated headache, even if the headache is diffuse or contralateral to the epileptogenic focus.
发作性癫痫性头痛（IEH）由局灶性癫痫发作引起。当头痛孤立存在且无其他症状时，诊断可能具有挑战性。
一名16岁女孩有5年双侧额颞部头痛病史，疼痛剧烈，持续1 - 3分钟。既往病史、体格检查及发育史均无异常。头部磁共振成像显示右侧海马硬化。视频脑电图监测确诊为单纯性IEH。额部头痛的发作与停止与右侧颞叶放电相关。该患者被诊断为右侧内侧颞叶癫痫。两年后，尽管使用了抗癫痫药物，她的癫痫发作仍增多。遂行右侧前颞叶切除术。患者术后10年无癫痫发作且无头痛。
即使头痛为弥漫性或与致痫灶对侧，在短暂孤立性头痛的鉴别诊断中也应考虑IEH。
