Abstracts

Rationale: Headache, and especially migraine, is often linked to epilepsy. Headache can be associated with epilepsy as preictal, ictal, or postictal phenomenon, but there are only limited reports of headache as an epileptic aura followed by other epileptic manifestation with EEG changes.Methods: Auras described by the patients were classified into 54 categories and analyzed retrospectively. We obtained the detailed features of headache in patients who described headache as an aura. Video-recorded clinical seizures, EEG findings and neuroimaging data were used to determine the ictal onset areas of the patients who had headache as an aura.Results: Among the 831 patients included, 55 had generalized seizures and 775 had partial seizures. While 457 patients did not experience an aura, 374 patients reported at least one aura. Five patients described headache as the most frequent aura, and headache was the second aura in one patient. All patients had partial seizures (two frontal lobe seizures, two temporal lobe seizures, and two parietal lobe seizures). The characteristics of headache were migraine-like in two patients, tension-type headache in another two patients, and hemicrania epileptic in the other two patients.Conclusions: Our study showed that headache is an uncommon feature of aura in adult epilepsy patients, and it can present as diverse features including tension-type headache, migraine-like headache, and hemicranias epileptica. Additional studies would be needed to localizing value of various types of headache in adult epilepsy patients.