Abstracts

Rationale: The high incidence of migraine headaches among epilepsy patients has been well established since the nineteenth century. However, it is not clear whether headaches are also common among patients with psychogenic non-epileptic seizures (NES). The primary objective of this study was to compare the prevalence of headache history in patients with epileptic seizure (ES) versus NES. The secondary objective was subgroup analysis of the prevalence of headache in each ES and NES groups based on gender difference. In addition, we also examined if the presence of headache history has any predicative value for the diagnosis of NES in both men and women. Methods: This retrospective cohort study reviewed 2,687 epilepsy monitoring unit (EMU) reports at the Barrow's Neurological Institute. For each patient, we recorded the presence or absence of headache history, gender, and the diagnosis of the EMU admission. Diagnosis of the EMU admission was classified as either ES or NES. For the purpose of this study, NES included both non-epileptic seizures and non-epileptic events. Reports with incomplete data, ambiguous diagnosis, and diagnoses of both ES and NES were all excluded from this study. Patients were divided into four groups: female patients with NES (f-NES), male patients with NES (m-NES), female patients with ES (f-ES), and male patients with ES (m-ES). We used chi-squared test for data analysis. Results: There were a total of 1,005 NES and 1,035 ES patients: 722 f-NES, 283 m-NES, 590 f-ES, 445 m-ES. There was significantly greater number of NES patients with headache compared to ES patients (48.2% of NES vs. 24.1% of ES, p < 0.004). Furthermore, there were more female patients than male patients with reported headache history regardless of the diagnosis (NES group: p < 0.001, ES group: p < 0.0001). When we specifically examined the female patients with headache history (n=542), significantly higher percentage of patients had the EMU diagnosis of NES compared to ES (68.6% had NES and 31.4% had ES, p < 0.0001). Similar but lesser degree of tendency was found in male with headache history. Conclusions: This study demonstrated that headaches are more commonly associated with diagnosis of NES than ES. Female patients more frequently report history of headaches than male among EMU population. In addition, the diagnosis of NES was much more likely in both female and male patients with headaches.