In clinical practice, the finding of headache and epilepsy in the same
patient and, moreover, in the presence of ictal and interictal epileptiform
EEG patterns in patients with headache, is well known. These
associations have stimulated research in the clinical and pathogenic
relationships between headache and epilepsy Studies of the incidence of this association in epileptics and headache
sufferers and an analysis of the link between the two different types of
attacks have led several authors to support a non-casual clinical association
between epilepsy and headache. So far, the pathophysiology of
this condition remains unknown [1].
In adult patients, several studies demonstrated, according to IHS criteria,
that the most common types of headache associated with epilepsy
were migraine and tension-type. However, the rate of unclassified
headaches has been remarkably high [2].
Probably, the most common relationship between seizures and
migraine is when migraine-like headaches occur after seizures.
Postictal headaches are often indistinguishable from migraine and are
equally common in patients with or without a family history of
migraine.
Epileptiform abnormalities have been revealed in 9–13% of patients
with migraine; this rate is significantly higher than expected from the
normal population. Simple and complex partial seizures, primary and
secondary generalized seizures, and tonic-clonic seizures have been
reported associated with headache.
It can be difficult to differentiate seizure disorders from migraine phenomena
(and vice versa) in some patients. It is particularly a problem
in children with atypical clinical presentations with or without abnormal
EEGs [3].
In the absence of EEG recorded seizures, it is not uncommon to
introduce an anticonvulsant if the history suggests a severe problem
compatible with a diagnosis of epilepsy. Remission of the suspected
events under anticonvulsant medication may indicate that the initial
diagnosis of epilepsy was correct. However, there is evidence
that in some patients, migraine phenomena also respond to these
drugs. Valproate, gabapentin, topiramate, and tiagabine have been
demonstrated to be efficacious. Furthermore, epileptic patients with
a history suggesting migraine require a combination of both
antiepileptic and antimigraine drugs in order to achieve full control
of epilepsy