Abstracts

Headache (HA) associated with epilepsy may be pre-ictal, ictal, post-ictal or inter-ictal. Pre-ictal headache (PIHA) has not been emphasized. Our purpose was to study clinical characteristics of PIHA in a group of patients with intractable partial epilepsy. We used a standardized interview in 100 consecutive patients undergoing comprehensive presurgical evaluation including video-EEG telemetry for medically intractable partial epilepsy. PIHA was subdivided into prodromic (prodPIHA: 24 hours-30 minutes prior to seizure onset) and early pre-ictal (earlyPIHA: within 30 minutes prior to seizure onset). For each HA type, subsequent questions inquired about HA lateralization, location, quality and severity of pain assessed by the visual analogue scale (VAS). Migrainous character of the HA and family history of recurrent HA or migraine were documented. Out of 100 patients, 11 (11%) had PIHA. Four had prodPIHA and 7 earlyPIHA.
Ten of these patients had temporal lobe epilepsy (TLE) and one had frontal epilepsy. Lateralization of HA was ipsilateral to the epileptic focus in 9 TLE patients and contralateral in 2 (one with TLE). All patients had frontotemporal PIHA. HA spread occurred in 3 patients with prodPIHA (ipsilateral 2, contralateral 1). Average intensity of PIHA was 6.8 in earlyPIHA and 7.5 in prodPIHA. Migrainous features were found in 4 patients. Family history of recurrent HA or migraine was found in all patients in prodPIHA and 1 patient in earlyPIHA. Frontotemporal pre-ictal headache is mostly ipsilateral to the seizure focus in TLE patients and has migrainous characteristics in about one third of patients. It may be a useful clinical lateralizing sign in patients undergoing presurgical evaluation.