Abstract
Since William Richard Gowers’ time, for over a hundred years, it has been discussing the possible link/comorbidity (causal or not causal) between epilepsy and headaches. During the latest decades, new data have emerged in favor of a non-random relationship between these two entities. They are both characterized by transient attacks of altered brain function with a clinical, pathophysiological, common genetic factors and therapeutic overlap, thus, they may also mimic each other. In fact, the clinical distinction between headache and epilepsy can be so difficult to make the differential diagnosis sometimes highly problematic. Both are common, often co-morbid and, in this latter case, headache attacks can be temporally related with the occurrence of epileptic seizures as pre-ictal, ictal, post-ictal or inter-ictal phenomenon. Yet, they are both paroxysmal and chronic neurological disorders that share many clinical and epidemiological aspects, and they may, both, present with visual, cognitive, sensitive-sensorial and motor signs/symptoms; these neurophysiologic phenomenon arise from the cerebral cortex and are modulated by sub-cortical connections.
Even from an epidemiological point of view data from the Literature about the co-morbidity between headache and epilepsy seem to be clearly different in children.
In addition, to make this scene even more variegated and complex, new data, supporting the possibility that a headache may even be, in some cases, “the only ictal manifestation of an epileptic seizure”, became available. This latter condition, the so-called “Ictal Epileptic Headache”, is a new entity that has recently been quoted in the new classification of headache disorders (ICHD-III, third edition, published in July 2014 in Cephalalgia), whose diagnostic criteria have also been suggested and published very recently.
Here it have been reported, in their essential aspects, the available data that during the latest decade have led to propose “diagnostic criteria” for “Ictal Epileptic Headache”. In this regards, in particular, it is crucial to stress that the Authors who proposed the diagnostic criteria for the “Ictal Epileptic Headache”, have “deliberately” and “consciously” chose to formulate “criteria” that underestimate the phenomenon rather than to spread the “panic” among patients and physicians who are reluctant to accept this concept because the stigma attached to the diagnosis of epilepsy. In the future, when this concept (an “headache” as sole ictal epileptic manifestation) will be “metabolized”, we will be able to propose “different and less restrictive” criteria than those recently published.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Anderman F (1987) Clinical features of migraine‐epilepsy syndrome. In: Andermann F, Lugaresi E (eds) Migraine and epilepsy. Butterworth Publishers, Boston, pp 20–89
Andermann F, Zifkin B (1998) The benign occipital epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine. Epilepsia 39:9–23
Ayata C (2010) Cortical spreading depression triggers migraine attack: pro. Headache 50(4):725–730
Ayata C, Jin H, Kudo C, Dalkara T, Moskowitz MA (2006) Suppression of cortical spreading depression in migraine prophylaxis. Ann Neurol 59(4):652–661
Baca CB, Vickrey BG, Caplan R, Vassar SD, Berg AT (2011) Psychiatric and medical comorbidity and quality of life outcomes in childhood-onset epilepsy. Pediatrics 128(6):e1532–e1543
Barré M, Hamelin S, Minotti L, Kahane P, Vercueil L (2008) Epileptic seizure and migraine visual aura: revisiting migralepsy. Rev Neurol (Paris) 164:246–252
Belcastro V, Striano P, Kasteleijn-Nolst Trenite DGA, Villa MP, Parisi P (2011a) Migralepsy, hemicrania epileptica post-ictal headache and ‘‘ictal epileptic headache’’: a proposal for terminology and classification revision. J Headache Pain 12:289–294
Belcastro V, Striano P, Parisi P (2011b) Seizure or migraine? The eternal dilemma. Comment on: “recurrent occipital seizures misdiagnosed as status migrainosus”. Epileptic Disord 13(4):456
Belcastro V, Striano P, Pierguidi L, Calabresi P, Tambasco N (2011c) Ictal epileptic headache mimicking status migrainosus: EEG and DWI-MRI findings. Headache 51:160–162
Belcastro V, Striano P, Parisi P. (2012) “Ictal epileptic headache”: beyond the epidemiological evidence. Epilepsy Behav 25(1):9–10
Belcastro V, Striano P, Parisi P (2013) From migralepsy to ictal epileptic headache: the story so far. Neurol Sci 34(10):1805–1807
Berg AT, Berkovic SF, Brodie MJ et al (2010) Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia 51:676–685
Berger M, Speckmann EJ, Pape HC, Gorji A (2008) Spreading depression enhances human neocortical excitability in vitro. Cephalalgia 28:558–562
Bladin PF (1987) The association of benign rolandic epilepsy with migraine. In: Andermann F, Lugaresi E (eds) Migraine and epilepsy. Butterworth Publishers, Boston, pp 145–52
Bolay H, Reuter U, Dunn AK, Huang Z, Boas DA, Moskowitz MA (2002) Intrinsic brain activity triggers trigeminal meningeal afferents in migraine model. Nat Med 8:136–142
Cai S, Hamiwka LD, Wirrell EC (2008) Peri-ictal headache in children: prevalence and character. Pediatr Neurol 39:91–96
Chen SC (2006) Epilepsy and migraine: the dopamine hypotheses. Med Hypotheses 66:466–472
Cianchetti C, Pruna D, Porcu L, Peltz MT, Ledda MG (2013) Pure epileptic headache and related manifestations: a video-EEG report and discussion of terminology. Epileptic Disord 15(1):84–92
Clarke T, Baskurt Z, Strug LJ et al (2009) Evidence of shared genetic risk factors for migraine and rolandic epilepsy. Epilepsia 50:2428–2433
Colombo B, Dalla Libera D, De Feo D, Pavan G, Annovazzi PO, Comi G (2011) Delayed diagnosis in pediatric headache: an outpatient Italian survey. Headache 51(8):1267–1273
De Fusco MM, Silvestri L et al (2003) Haploinsufficiency of ATP1A2 encoding the Na + /K + pump a2 subunit associated with familial hemiplegic migraine type 2. Nat Genet 33:192–196
de Souza TK, e Silva MB, Gomes AR, de Oliveira HM, Moraes RB, de Freitas Barbosa CT et al (2011) Potentiation of spontaneous and evoked cortical electrical activity after spreading depression: in vivo analysis in wellnourished and malnourished rats. Exp Brain Res 214:463–469
De Vries B, Frants RR, Ferrari MD, van den MAM (2009) Molecular genetics of migraine. Hum Genet 126:115–132
Dichgans M, Freilinger T, Eckstein G, Babini E, Lorenz-Depiereux B, Biskup S (2005) Mutations in the neuronal voltage-gated sodium channel SCN1A in familial hemiplegic migraine. Lancet 366:371–377
Eikermann-Haerter K, Ayata C (2010) Cortical spreading depression and migraine. Curr Neurol Neurosci Rep 10(3):167–173
Escayg A, Goldin AL (2010) Critical review and invited commentary: sodium channel SCN1A and epilepsy: mutations and mechanisms. Epilepsia 51:1650–1658
Fabricius M, Fuhr S, Willumsen L, Dreier JP, Bhatia R, Boutelle MG et al (2008) Association of seizures with cortical spreading depression and peri-infarct depolarisations in the acutely injured human brain. Clin Neurophysiol 119(9):1973–1984
Fanella M, Fattouch J, Casciato S, Lapenta L, Morano A, Egeo G et al (2012) Ictal epileptic headache as ‘‘subtle’’ symptom in generalized idiopathic epilepsy. Epilepsia 53(4):e67–e70
Faraguna U, Nelson A, Vyazovskiy VV, Cirelli C, Tononi G (2010) Unilateral cortical spreading depression affects sleep need and induces molecular and electrophysiological signs of synaptic potentiation in vivo. Cereb Cortex 20:2939–2947
Ferrie CD, Caraballo R, Covanis A et al (2007)Autonomic status epilepticus in Panayiotopoulos syndrome and other childhood and adult epilepsies: a consensus view. Epilepsia 48(6):1165–1172
Fogarasi A, Janszky J, Tuxhorn I (2006) Autonomic symptoms during childhood partial epileptic seizures. Epilepsia 47:584–588.
Forderreuther S, Henkel A, Noachtar S et al (2002) Headache associated with epileptic seizures: epidemiology and clinical characteristics. Headache 42:649–655
Fusco L, Specchio N, Ciofetta G, Longo D, Trivisano M, Vigevano (2011) Migraine triggered by epileptic discharges in a Rasmussen's encephalitis patient after surgery. Brain Dev 33:597–600
Gambardella A, Marini C (2009) Clinical spectrum of SCN1A mutations. Epilepsia 50:20–23
Ghadiri MK, Kozian M, Ghaffarian N, Stummer W, Kazemi H, Speckmann EJ et al (2012) Sequential changes in neuronal activity in single neocortical neuron after spreading depression. Cephalalgia 32(2):116–124
Ghofrani M, Mahvelati F, Tonekaboni H (2006) Headache as a sole manifestation in nonconvulsive status epilepticus. J Child Neurol 21:981–983
Gigout S, Louvel J, Kawasaki H, D’Antuono M, Armand V, Kurcewicz I (2006) Effects of gap junction blockers on human neocortical synchronization. Neurobiol Dis 22:496–508
Grossman RM, Abramovich I, Lefebvre AB (1971) Epileptic headache: report of a case with EEG recorded during the crisis. Arq Neuropsiquiatr (San Paulo) 29:198–206
Hauser AW, Annegers JF, Anderson EV, Kurlan LT (1993) The incidence of epilepsy and unprovoked seizure in Rochester, Minnesota, 1935–1984. Epilepsia 34:453–468
Heyck H, Hess R (1955) Vasomotoric headaches as symptom of masked epilepsy. Schweiz Med Wochenschr J Suisse Med 85(24):573–575
International Headache Society (2004) The international classification of headache disorders: 2nd edition. Cephalalgia 24(1):9–160
International Headache Society. (2013) The international classification of headache disorders: third edition. Cephalalgia 33(9):629–808
Isler H, Wieser HG, Egli M (1987) Hemicrania epileptica: synchronous ipsilateral ictal headache with migraine features. In: Andermann F, Lugaresi E (eds) Migraine and epilepsy. Butterworth Publishers, Boston, pp 249–263
Italiano D, Grugno R, Calabro‘ RS, Bramanti P, Di Maria F, Ferlazzo E (2011) Recurrent occipital seizures misdiagnosed as status migrainosus. Epileptic Disord 13:197–201
Ito M, Adachi N, Nakamura F et al (2003) Multi‐center study on post‐ictal headache in patients with localization‐related epilepsy. Psychiatry Clin Neurosci 57:385–389
Ito M, Adachi N, Nakamura F et al (2004) Characteristics of postictal headache in patients with partial epilepsy. Cephalalgia 24(1):23–28
Jen JC, Wan J, Palos TP (2005) Mutations in the glutamate transporter EAAT1 causes episodic ataxia, hemiplegia, and seizures. Neurology 65:529–534
Johnson MP, Griffiths LR (2005) A genetic analysis of serotonergic biosynthetic and metabolic enzymes in migraine using a DNA pooling approach. J Hum Genet 50:607–610
Kasteleijn-Nolst Trenité DGA, Verrotti A, Di Fonzo A et al (2010a) Headache, epilepsy and photosensitivity: how are they connected? J Headache Pain 11:469–476
Kasteleijn-Nolst TDGA, Cantonetti L, Parisi P (2010b) Visual stimuli, photosensitivity and photosensitive epilepsy. Chapter 94. In: Shorvon S, Guerrini R, Andermann F (eds) Common and uncommon causes of epilepsy. Cambridge University, Cambridge
Kasteleijn-Nolst Trenité DGA, Parisi P (2012) Migraine in the borderland of epilepsy: “migralepsy” an overlapping syndrome of children and adults? Epilepsia 53(Suppl 7):20–25
Kinast M, Lueders H, Rothner AD et al (1982) Benign focal epileptiform discharges in childhood migraine. Neurology 32:1309–1311
Koutroumanidis M (2007) Panayiotopoulos syndrome: an important electroclinical example of benign childhood system epilepsy. Epilepsia 48:1044–1053
Laplante P, Saint-Hilaire JM, Bouvier G (1983) Headache as an epileptic manifestation. Neurology 33:1493–1495
Lateef TM, Cui L, Nelson KB, Nakamura EF, Merikangas KR (2012) Physical comorbidity of migraine and other headaches in US adolescents. J Pediatr 161(2):308–313
Leniger T, Isbruch K, Driesch S, Diener HC, Hufnagel A (2001) Seizure-associated headache in epilepsy. Epilepsia 42:1176–1179
Lennox WG, Lennox MA (1960) Epilepsy and related disorders. Little Brown, Boston, p 451
Lipton RB, Silberstein SD (1994) Why study the comorbidity of migraine? Neurology 44(10, Suppl 7):S4–S5
Lipton RB, Ottman R, Ehrenberg BL, Hauser WA (1994a) Comorbidity of migraine: the connection between migraine and epilepsy. Neurology 44(Suppl 7):S28–S32
Lonnqvist T, Paeteau A, Valanne L, Pihko H (2009) Recessive twinkle mutations cause severe epileptic encephalopathy. Brain 132:1553–1562
Lugaresi E (1955) EEG investigations in monosymptomatic headache in infants. Riv Neurol 25(4):582–588
Lyngberg AC, Rasmussen BK, Jørgensen T, Jensen R (2005) Incidence of primary headache: a Danish epidemiologic follow-up study. Am J Epidemiol 161(11):1066–1073
Marks DA, Ehrenberg BL (1993) Migraine-related seizures in adults with epilepsy, with EEG correlation. Neurology 43:2476–2483
Morocutti C, Vizioli R (1957) Episodes of paroxysmal headache as the only clinical manifestation of idiopathic epilepsy. Riv Neurol 27(4):427–430
Moskowitz MA, Nozaki K, Kraig RP (1993) Neocortical spreading depression provokes the expression of C‐fos proteinlike immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. J Neurosci 13:1167–1177
Niedermeyer E (1993) Migraine‐triggered epilepsy. Clin EEG 24:37–43
Nobili L (2007) Nocturnal frontal lobe epilepsy and non‐rapid eye movement sleep parasomnias: differences and similarities. Sleep Med Rev 11:251–254
Nymgard K. (1956) Epileptic headache. Acta Psych Neurol Scand: Suppl 108:291–300
Olafsson E, Ludvigsson P, Gudmundsson G, Hesdorffer D, Kjartansson O, Hauser WA (2005) Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: a prospective study. Lancet Neurol 4(10):627–634
Panayiotopoulos CP (1987) Difficulties in differentiating migraine and epilepsy based on clinical EEG findings. In: Andermann F, Lugaresi E (eds) Migraine and epilepsy. Butterworth Publishers, Boston, pp 142–151
Panayiotopoulos CP (1999a) Visual phenomena and headache in occipital epilepsy: a review, a systematic study and differentiation from migraine. Epileptic Disord 1:205–216
Panayiotopoulos CP (1999b) Differentiating occipital epilepsies from migraine with aura, acephalic migraine and basilar migraine. In: Panayiotopoulos CP (ed) Benign childhood partial seizures and related epileptic syndromes. John Libbey & Company Ltd, London, pp 281–302
Panayiotopoulos CP (1999c) Elementary visual hallucination, blindness, and headache in idiopathic occipital epilepsy: differentiation from migraine. J Neurol Neurosurg. Psychiatry 66:536–540
Panayiotopoulos CP (2012) The new ILAE report on terminology and concepts for the organization of epilepsies: critical review and contribution. Epilepsia 53(3):399–404
Parisi P (2009a) Who’s still afraid of the link between headache and epilepsy? Some reactions to and reflections on the article by Marte Helene Bjørk and co-workers. J Headache Pain 10(5):327–329
Parisi P (2009b) Why is migraine rarely, and not usually, the sole ictal epileptic manifestation? Seizure 18(5):309–312
Parisi P (2011) Comments on the article by Fusco L. et al. entitled “Migraine triggered by epileptic discharges in a Rasmussen’s encephalitis patient after surgery”. Brain Dev 33(8):704–705
Parisi P, Kasteleijn-Nolst Trenite DGA. (2010) “Migralepsy”: a call for revision of the definition. Epilepsia 51(5):932–933
Parisi P, Kasteleijn-Nolst TDG, Piccioli M et al (2007) A case with atypical childhood occipital epilepsy ‘‘Gastaut type’’: an ictal migraine manifestation with a good response to intravenous diazepam. Epilepsia 48:2181–2186
Parisi P, Piccioli M, De Sneeuw S, de Sneeuw S, de Kovel C, van Nieuwenhuizen O, Buttinelli C, Villa MP, Kasteleijn-Nolst Trenité DG (2008a) Redefining headache diagnostic criteria as epileptic manifestation? Cephalalgia 28:408–409
Parisi P, Piccioli M, Villa MP, Buttinelli C, Kasteleijn-Nolst Trenéte DGA (2008b) Hypothesis on neurophysiopathological mechanisms linking epilepsy and headache. Med Hypoth 70:1150–1154
Parisi P, Striano P, Kasteleijn-Nolst Trenite DGA et al (2012a) “Ictal Epileptic Headache”: recent concepts for new classifications criteria. Cephalalgia 32(9):723–724
Parisi P, Striano P, Negro A, Martelletti P, Belcastro V (2012b) Ictal epileptic headache: an old story with courses and appeals. J Headache Pain 13(8):607–613
Parisi P, Striano P, Belcastro V (2013a) The crossover between headache and epilepsy. Expert Rev Neurother 13(3):231–233
Parisi P, Striano P, Verrotti A, Villa MP, Belcastro V (2013b) What have we learned about ictal epileptic headache? A review of well-documented cases. Seizure 22(4):253–258
Perucca P, Terzaghi M, Manni R (2010) Status epilepticus migrainosus: clinical, electrophysiologic, and imaging characteristics. Neurology 75:373–374
Piccioli M, Parisi P, Tisei P, Villa MP, Buttinelli C, Kasteleijn-Nolst Trenité DGA (2009) Ictal headache and visual sensitivity. Cephalalgia 29:194–203
Piccinelli P, Borgatti R, Nicoli F et al (2006) Relationship between migraine and epilepsy in paediatric age. Headache 46:413–421
Pietrobon D (2010) Biological science of headache channels. Handb Clin Neurol 97:73–83
Pinto DJ, Patrick SL, Huang WC, Connors BW (2005) Initiation, propagation and termination of epileptiform activity in rodent neocortex in vitro involve distinct mechanisms. J Neurosci 25(36):8131–8140
Riant F, Ducros A, Ploton C, Banbance C, Depienne C, Tournie-Lasserve E (2010) De novo mutations in ATP1A2 and CACNA1A are frequent in early-onset sporadic hemiplegic migraine. Neurology 75:967–972
Sances G, Guaschino E, Perucca P, Allena M, Ghiotto N, Manni R (2009) Migralepsy: a call for revision of the definition. Epilepsia 50:2487–2496
Sasmaz T, Bugdayci R, Ozge A, Karakelle A, Kurt O, Kaleagasi H (2004) Are parents aware of their schoolchildren’s headaches? Eur J Public Health 14(4):366–368
Somjen GG (2001) Mechanisms of spreading depression and hypoxic spreading depression‐like depolarization. Physiol Rev 81:1065–1096
Steinlein OK (2004) Genetic mechanisms that underlie epilepsy. Nat Rev Neurosci 5:400–408
Striano P, Belcastro V, Parisi P (2011) Status epilepticus migrainosus: clinical, electrophysiologic, and imaging characteristics. Neurology 76:761
Striano P, Belcastro V, Parisi P (2012) From ‘‘migralepsy’’ to ‘‘ictal epileptic headache’’ concept. Epilepsy Behav 23(3):392
Tamura K, Alessandri B, Heimann A, Kempski O (2011) The effects of a gap‐junction blocker, carbenoxolone, on ischemic brain injury and cortical spreading depression. Neuroscience 194:262–271
Toldo I, Perissinotto E, Menegazzo F et al (2010) Comorbidity between headache and epilepsy in a pediatric headache center. J Headache Pain 11:235–240
Tonini MC, Giordano L, Atzeni L (2012) Primary headache and epilepsy: a multicenter cross-sectional study. Epilepsy Behav 23:342–347
Tottene A, Conti R, Fabbro A, Vecchia D, Shapovalova M, Santello M, van den Maagdenberg AM, Ferrari MD, Pietrobon D (2009) Enhanced excitatory transmission at cortical synapses as the basis for facilitated spreading depression in Ca(v)2.1 knockin migraine mice. Neuron 61(5):762–773
Tottene A, Urbani A, Pietrobon D (2011) Role of different voltage-gated Ca2 + channels in cortical spreading depression. Channels (Austin) 5(2):110–114
Tzoulis C, Engelsen BA, Telstad W (2006) The spectrum of clinical disease caused by the A467T and W748S POLG mutations: a study of 26 causes. Brain 129:1685–1692
Uchitel OD, Inchauspe CG, Urbano FJ, Di Guilmi MN (2012) Ca(V)2.1 voltage activated calcium channels and synaptic transmission in familial hemiplegic migraine pathogenesis. J Physiol Paris 106(1–2):12–22
Vanmolkot KR, Kors EE, Hottenga JJ, Terwindt GM, Haan JJ, Hoefnagels WA (2003) Novel mutations in the Na + /K + -ATPase pump gene ATP1A2 associated with familial hemiplegic migraine and benign familial infantile convulsions. Ann Neurol 54:360–366
Verrotti A, Coppola G, Spalice A et al (2011a) Peri‐ictal and inter‐ictal headache in children and adolescents with idiopathic epilepsy: a multicenter cross-sectional study. Childs Nerv Syst 27:1419–1423
Verrotti A, Coppola G, Di Fonzo A et al (2011b) Should “migralepsy” be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature. Epilepsy Behav 21(1):52–59
Verrotti A, Striano P, Belcastro C et al (2011c) Migralepsy and related conditions: advances in pathophysiology and classification. Seizure 20:271–275
Walker MC, Smith SJM, Sisodya SM, Shorvon SD (1995) Case of simple partial status epilepticus in occipital lobe epilepsy misdiagnosed as migraine: clinical, electrophysiological, and magnetic resonance imaging characteristics. Epilepsia 36:1233–1236
Walser H, Isler H (1982) Frontal intermittent rhythmic delta activity. Impairment of consciousness and migraine. Headache 22(2):74–80
Wendorff J, Juchniewicz B (2005) Photosensitivity in children with idiopathic headaches. Neurol Neurochir Pol 39(4 Suppl 1):S9–S16
Wirrell EC, Hamiwka LD (2006) Do children with benign rolandic epilepsy have a higher prevalence of migraine than those with other partial epilepsies or nonepilepsy controls? Epilepsia 47:1674–1681
Yamamane LE, Montenegro MA, Guerreiro MM (2004) Comorbidity headache and epilepsy in childhood. Neuropediatrics 35(2):99–102
Yankovsky AE, Andermann F, Bernasconi A (2005) Characteristics of headache associated with intractable partial epilepsy. Epilepsia 46:1241–1245
Zhang X, Levy D, Kainz V, Noseda R, Jakubowski M, Burstein R (2011) Activation of central trigeminovascular neurons by cortical spreading depression. Ann Neurol 69(5):855–865
Acknowledgments
My interest and my commitment to research in the field of pediatric neurology have been made possible only by the patience, trust and love of my parents, Maria and Alfonso, my son, Eduardo Alfonso, and my wife, Loredana, to whom I will forever be indebted, as well as by the support of all the people I have met over the years.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Parisi, P. (2015). The Complex Relationship Between Epilepsy and Headache and the Concept of Ictal Epileptic Headache. In: Striano, P. (eds) Epilepsy Towards the Next Decade. Contemporary Clinical Neuroscience. Springer, Cham. https://doi.org/10.1007/978-3-319-12283-0_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-12283-0_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-12282-3
Online ISBN: 978-3-319-12283-0
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)