Ictal headache

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Ictal headache (Headache and Epilepsy)
Specialty Neurology

A headache is often present in patients with epilepsy. If the headache occurs in the vicinity of a seizure, it is defined as peri-ictal headache, which can occur either before (pre-ictal) or after (post-ictal) the seizure, to which the term ictal refers. An ictal headache [1] itself may or may not be an epileptic manifestation. In the first case it is defined as ictal epileptic headache [2] or simply epileptic headache. [3] It is a real painful seizure, that can remain isolated or be followed by other manifestations of the seizure. [3] On the other hand, the ictal non-epileptic headache is a headache that occurs during a seizure but it is not due to an epileptic mechanism. When the headache does not occur in the vicinity of a seizure it is defined as inter-ictal headache. In this case it is a disorder autonomous from epilepsy, that is a comorbidity.

Contents

Definitions

Pre-ictal headache.

The most frequent pre-ictal headache is that of a seizure occurring during or within one hour after an attack of migraine with aura, defined Migraine aura-triggered seizure [4] or Migralepsy. However, the condition can also occur in connection with an attack of migraine without aura or of a non-migrainous headache. [5] Only an EEG during the headache can determine whether it is a true migraine or an epileptic headache (in this second case epileptiform anomalies are detectable during the headache phase).[ citation needed ]

Post-ictal headache.

It is a headache “occurring within three hours after an epileptic seizure and remitting spontaneously within 72 hours after seizure termination”. [4] It is one of the possible symptoms of the postictal state. Post-ictal headache is the most frequent association between headache and epilepsy, occurring between 12% and 52% of people with epilepsy. [6] Post-ictal headache has migrainous features in about half of the cases. It is more frequent after generalized tonic-clonic seizures, in temporal and occipital lobe epilepsy and in those with inter-ictal headache.[ citation needed ]

Inter-ictal headache.

Patients with epilepsy may also experience any type of headache, having its occurrence independent of the epileptic seizures, although occasionally near it (after or before). This is a comorbid condition, to be kept separate from the above-reported peri-ictal and ictal headaches. [5]

Ictal headache

1.Ictal epileptic headache (IEH) [2] [4] or, more simply, Epileptic headache (EH, since the term "ictal" is pleonastic, as a headache manifestation of an epileptic seizure is by definition ictal). [3] This is a rare form of painful seizure. [3] [7] EH may be the initial phase (so-called aura, necessarily with awareness) of an epileptic seizure, which then continues with other manifestations, for example convulsions. But EH is of greater clinical importance when it is an isolated event ("pure EH" [8] ), i.e. not followed by other manifestations that clarify its epileptic nature.

Symptoms and diagnosis. EH has no clinical elements allowing a diagnosis. The characteristics and location of the pain in EH can be different: sometimes migraine-like with or without aura, sometimes tension-type, sometimes indefinable. The duration of an episode of EH may last for seconds, but even for days (headache/status epilepticus [9] ).

For the diagnosis it is necessary to perform an EEG during the headache that shows epilepsy-compatible discharges coinciding with the onset and cessation of the headache.

The so-called hemicrania epileptica is a variant of EH characterized by the fact that head pain and EEG paroxysms are located on the same side.

MRI is necessary to establish the cause, which, as in all focal epilepsies, can be varied: malformations/dysplasia, neoplasms, encephalopathies, traumatic brain injury, vasculopathies. [3]

Therapy. It depends on the etiology. During the headache, like most seizures, i.v. benzodiazepines are usually effective. Antiepileptic drugs can be used as preventive.

2. Ictal non-epileptic headache. Rare cases are reported. [10] It is a condition that can be differentiated with certainty from the previous one if the headache episode is also present outside the seizure, that is, before and/or after, without specific EEG abnormalities. [5]

Related Research Articles

<span class="mw-page-title-main">Migraine</span> Disorder resulting in recurrent moderate-severe headaches

Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include nausea, vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation of headache symptoms during physical activity is another distinguishing feature. Up to one-third of migraine sufferers experience aura: a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks, consisting of as little as several lifetime attacks, to chronic disease.

<span class="mw-page-title-main">Seizure</span> Period of symptoms due to excessive or synchronous neuronal brain activity

An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness, to shaking movements involving only part of the body with variable levels of consciousness, to a subtle momentary loss of awareness. Most of the time these episodes last less than two minutes and it takes some time to return to normal. Loss of bladder control may occur.

<span class="mw-page-title-main">Aura (symptom)</span> Symptom of epilepsy and migraine

An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a seizure.

Frontal lobe epilepsy (FLE) is a neurological disorder that is characterized by brief, recurring seizures arising in the frontal lobes of the brain, that often occur during sleep. It is the second most common type of epilepsy after temporal lobe epilepsy (TLE), and is related to the temporal form in that both forms are characterized by partial (focal) seizures.

Myoclonic epilepsy refers to a family of epilepsies that present with myoclonus. When myoclonic jerks are occasionally associated with abnormal brain wave activity, it can be categorized as myoclonic seizure. If the abnormal brain wave activity is persistent and results from ongoing seizures, then a diagnosis of myoclonic epilepsy may be considered.

The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterized by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms.

Abdominal epilepsy is a rare condition most frequently found in children, consisting of gastrointestinal disturbances caused by epileptiform seizure activity. Though a few cases of it have been reported in adults too. It has been described as a type of temporal lobe epilepsy. Responsiveness to anticonvulsants can aid in the diagnosis. Distinguishing features of abdominal epilepsy include (1) Abnormal laboratory, radiographic, and endoscopic findings revealing paroxysmal GI manifestations of unknown origin (2) CNS symptoms (3) Abnormal EEG. Most published medical literature dealing with abdominal epilepsy is in the form of individual case reports. A 2005 review article found a total of 36 cases described in the medical literature.

Todd's paresis is focal weakness in a part or all of the body after a seizure. This weakness typically affects the limbs and is localized to either the left or right side of the body. It usually subsides completely within 48 hours. Todd's paresis may also affect speech, eye position (gaze), or vision.

<span class="mw-page-title-main">Generalized tonic–clonic seizure</span> Type of generalized seizure that affects the entire brain

A generalized tonic–clonic seizure, commonly known as a grand mal seizure or GTCS, is a type of generalized seizure that produces bilateral, convulsive tonic and clonic muscle contractions. Tonic–clonic seizures are the seizure type most commonly associated with epilepsy and seizures in general and the most common seizure associated with metabolic imbalances. It is a misconception that they are the sole type of seizure, as they are the main seizure type in approximately 10% of those with epilepsy.

<span class="mw-page-title-main">Rolandic epilepsy</span> Most common epilepsy syndrome in childhood, usually subsiding with age

Benign Rolandic epilepsy or self-limited epilepsy with centrotemporal spikes is the most common epilepsy syndrome in childhood. Most children will outgrow the syndrome, hence the label benign. The seizures, sometimes referred to as sylvian seizures, start around the central sulcus of the brain.

Panayiotopoulos syndrome is a common idiopathic childhood-related seizure disorder that occurs exclusively in otherwise normal children and manifests mainly with autonomic epileptic seizures and autonomic status epilepticus. An expert consensus has defined Panayiotopoulos syndrome as "a benign age-related focal seizure disorder occurring in early and mid-childhood. It is characterized by seizures, often prolonged, with predominantly autonomic symptoms, and by an EEG [electroencephalogram] that shows shifting and/or multiple foci, often with occipital predominance."

New daily persistent headache (NDPH) is a primary headache syndrome which can mimic chronic migraine and chronic tension-type headache. The headache is daily and unremitting from very soon after onset, usually in a person who does not have a history of a primary headache disorder. The pain can be intermittent, but lasts more than 3 months. Headache onset is abrupt and people often remember the date, circumstance and, occasionally, the time of headache onset. One retrospective study stated that over 80% of patients could state the exact date their headache began.

The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders (ICHD). The current version, the ICHD-3 beta, was published in 2013.

Migralepsy is a rare condition in which a migraine is followed, within an hour period, by an epileptic seizure. Because of the similarities in signs, symptoms, and treatments of both conditions, such as the neurological basis, the psychological issues, and the autonomic distress that is created from them, they individually increase the likelihood of causing the other. However, also because of the sameness, they are often misdiagnosed for each other, as migralepsy rarely occurs.

Abdominal aura, also known as visceral aura and epigastric aura, is a type of somatosensory aura that typically manifests as abdominal discomfort in the form of nausea, malaise, hunger, or pain. Abdominal aura is typically associated with epilepsy, especially temporal lobe epilepsy, and it can also be used in the context of migraine. The term is used to distinguish it from other types of somatosensory aura, notably visual disturbances and paraesthesia. The abdominal aura can be classified as a somatic hallucination. Pathophysiologically, the abdominal aura is associated with aberrant neuronal discharges in sensory cortical areas representing the abdominal viscera.

Forced Normalization (FN) is a psychiatric phenomenon in which a long term episodic epilepsy or migraine disorder is treated, and, although the electroencephalogram (EEG) appears to have stabilized, acute behavioral, mood, and psychological disturbances begin to manifest. If, or when, treatment for the disorder is halted, the disturbances go away, but the episodic spikes on the EEG reappear. H. Landolt coined the term 'Forced Normalization' in 1953 in response to a change he witnessed in epileptic EEGs, which monitor electrical activity in the brain. These changes were followed by abrupt behavioral changes in the patient. Landolt concluded that forced normalization is "the phenomenon characterized by the fact that, with the occurrence of psychotic states, the electroencephalography becomes more normal or entirely normal, as compared with previous and subsequent EEG findings." Forced normalization, as described by Landolt, was therefore an electrophysiological phenomenon with the electroencephalograph at its helm.

Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a pure but rare form of idiopathic occipital epilepsy that affects otherwise normal children and adolescents. It is classified amongst benign idiopathic childhood focal epilepsies such as rolandic epilepsy and Panayiotopoulos syndrome.

<span class="mw-page-title-main">Occipital epilepsy</span> Medical condition

Occipital epilepsy is a neurological disorder that arises from excessive neural activity in the occipital lobe of the brain that may or may not be symptomatic. Occipital lobe epilepsy is fairly rare, and may sometimes be misdiagnosed as migraine when symptomatic. Epileptic seizures are the result of synchronized neural activity that is excessive, and may stem from a failure of inhibitory neurons to regulate properly.

A migrainous infarction is a rare type of ischaemic stroke which occurs in correspondence with migraine aura symptoms. Symptoms include headaches, visual disturbances, strange sensations and dysphasia, all of which gradually worsen causing neurological changes which ultimately increase the risk of an ischaemic stroke. Typically, women under the age of 45 who experience migraine with aura (MA) are at the greatest risk for developing migrainous infarction, especially when combined with smoking and use of oral contraceptives.

Menstrual migraine is term used to describe both true menstrual migraines and menstrually related migraines. About 7%–14% of women have migraines only at the time of menstruation, these are called true menstrual migraines. Most female migraneurs experience migraine attacks throughout the menstruation cycle with an increased number perimenstrually, these are referred to as menstrually related or menstrually triggered migraine.

References

  1. ↑ Piccioli M, Parisi P, Tisei P, Villa MP, Buttinelli C, Kasteleijn-Nolst Trenité DG (February 2009). "Ictal headache and visual sensitivity". Cephalalgia. 29 (2): 194–203. doi:10.1111/j.1468-2982.2008.01707.x. PMID   18823360. S2CID   7911641.
  2. 1 2 Parisi P, Verrotti A, Costa P, Striano P, Zanus C, Carrozzi M, Raucci U, Villa MP, Belcastro V (September 2015). "Diagnostic criteria currently proposed for "ictal epileptic headache": perspectives on strengths, weaknesses and pitfalls". Seizure. 31 (2): 56–63. doi: 10.1016/j.seizure.2015.07.005 . PMID   26362378. S2CID   18739241.
  3. 1 2 3 4 5 Cianchetti C, Dainese F, Ledda MG, Avanzini G (November 2017). "Epileptic headache: a rare form of painful seizure". Seizure. 52: 169–175. doi: 10.1016/j.seizure.2017.10.010 . PMID   29054038.
  4. 1 2 3 Headache Classification Committee of the International Headache Society (IHS) (January 2018). "The International Classification of Headache Disorders, 3rd edition". Cephalalgia. 38 (1): 1–211. doi: 10.1177/0333102417738202 . PMID   29368949. S2CID   45901670.
  5. 1 2 3 Cianchetti C, Avanzini G, Dainese F, Guidetti V (June 2017). "The complex interrelations between two paroxysmal disorders: headache and epilepsy". Neurological Sciences. 38 (6): 941–948. doi:10.1007/s10072-017-2926-5. PMID   28341968. S2CID   4228459.
  6. ↑ Ekstein D, Schachter SC (October 2010). "Postictal headache". Epilepsy & Behavior. 19 (2): 151–155. doi:10.1016/j.yebeh.2010.06.023. PMID   20829119. S2CID   44473900.
  7. ↑ Hwang ST, Goodman T, Stevens SJ (September 2019). "Painful seizures: a review of epileptic ictal pain". Curr. Pain Headache Rep. 23 (11): 169–175. doi:10.1007/s11916-019-0825-6. PMID   31506775. S2CID   202160283.
  8. ↑ Cianchetti C, Pruna D, Porcu L, Peltz MT, Ledda MG (March 2013). "Pure epileptic headache and related manifestations: a video-EEG report and discussion of terminology". Epileptic Disorders. 15 (1): 84–92. doi: 10.1684/epd.2013.0552 . PMID   23518661.
  9. ↑ Belcastro V, Striano P, Pierguidi L, Calabresi P, Tambasco N (January 2011). "Ictal epileptic headache mimicking status migrainosus: EEG and DWI-MRI findings". Headache. 51 (1): 160–162. doi:10.1111/j.1526-4610.2010.01709.x. PMID   20553328. S2CID   24924404.
  10. ↑ Mainieri G, Cevoli S, Giannini G, Zummo L, Leta C, Broli M, Ferri L, Santucci M, Posar A, Avoni P, Cortelli P, Tinuper P, Bisulli F (August 2015). "Headache in epilepsy: prevalence and clinical features". J. Headache Pain. 16: 556. doi: 10.1186/s10194-015-0556-y . PMC   4540713 . PMID   26245188.
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