Headache in epilepsy: prevalence and clinical features

G. Mainieri, S. Cevoli, G. Giannini, L. Zummo, C. Leta, M. Broli, L. Ferri, M. Santucci, A. Posar, P. Avoni, P. Cortelli, P. Tinuper, Francesca Bisulli

Research output: Contribution to journalArticlepeer-review


Background: Headache and epilepsy are two relatively common neurological disorders and their relationship is still a matter of debate. Our aim was to estimate the prevalence and clinical features of inter-ictal (inter-IH) and peri-ictal headache (peri-IH) in patients with epilepsy. Methods: All patients aged ≥ 17 years referring to our tertiary Epilepsy Centre were consecutively recruited from March to May 2011 and from March to July 2012. They underwent a semi-structured interview including the International Classification Headache Disorders (ICHD-II) criteria to diagnose the lifetime occurrence of headache.χ2-test, t-test and Mann–Whitney test were used to compare clinical variables in patients with and without inter-IH and peri-IH. Results: Out of 388 enrolled patients 48.5 % had inter-IH: migraine in 26.3 %, tension-type headache (TTH) in 19.1 %, other primary headaches in 3.1 %. Peri-IH was observed in 23.7 %: pre-ictally in 6.7 %, ictally in 0.8 % and post-ictally in 19.1 %. Comparing patients with inter-ictal migraine (102), inter-ictal TTH (74) and without inter-IH (200), we found that pre-ictal headache (pre-IH) was significantly represented only in migraineurs (OR 3.54, 95 % CI 1.88-6.66, P <0.001). Post-ictal headache (post-IH) was significantly associated with both migraineurs (OR 2.60, 95 % CI 1.85-3.64, P <0.001) and TTH patients (OR 2.05, 95 % CI 1.41-2.98, P <0.001). Moreover, post-IH was significantly associated with antiepileptic polytherapy (P <0.001), high seizure frequency (P = 0.002) and tonic-clonic seizures (P = 0.043). Conclusions: Migraine was the most represented type of headache in patients with epilepsy. Migraineurs are more prone to develop pre-IH, while patients with any inter-IH (migraine or TTH) are predisposed to manifest a post-IH after seizures.

Original languageEnglish
Article number72
JournalJournal of Headache and Pain
Issue number1
Publication statusPublished - Dec 7 2015


  • Epilepsy
  • Headache
  • Migraine
  • Post-ictal headache
  • Pre-ictal headache

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology


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