Headache and epilepsy

Background: Headache is one of the most common comorbidities in epilepsy thatcould be independent or temporally related to the occurrence of seizures, as pre-ictal, ictal, post-ictal or inter-ictal events. Also, headache may be the only ictal manifestation of a seizure.This review aimed to assess the association of headache and epilepsy.Method: Pubmed, Scopus, Embase and Cochrane have been searched within 1990-2017 interval using the following keywords: epilepsy, headache, epileptic headache, ictal headache, pre-, post- andinter-ictal headache, hemicraniaepileptica, migralepsy and migraine-triggered seizure. The articles were reviewed and relevant data was extracted.Results: The prevalence of migraine among patients with epilepsy has been reported as 8-32.9% which is significantly higher than general population. However a few studies suggested no certain relationship between these disorders. Coexistence of tension-type headache and epilepsy is more controversial. Pre-ictal headache is defined as a headache preceding a seizure. If the interval between headache and seizure exceedsan hour, the definition is inter-ictal headache and in the lack of any interval, the headache could be an ictalevent which needs concomitant EEG findings to be proved. The most frequent association between headache andepilepsy is reported in post-ictal headaches with a prevalence of 12-52%. They are more frequent after generalized tonic-clonic seizures but also commonly occur after focal seizures particularly those of occipital origin. Conclusion: Current classification of epilepsy-related headaches has some weaknesses which sometimes makes the definite assortment difficult. More detailed studies with large sample sizes are needed to provide a more accurate classification.