Headache and epilepsy comorbidity in children: a critical review of the literature

Key words: Ictal epileptic headache, Migraine, Epilepsy, Comorbidity, EEG

Headache and epilepsy are both chronic neurologic disorders with episodic manifestations and typical symptoms that enable to distinguish between them in most of the cases. Rarely, migraine with headache and/or tension-type headache may be the sole symptom of an epileptic seizure. The comorbidity epilepsy/headache is very frequent in children affected by epilepsy with centrotemporal spikes (BECTS), juvenile myoclonic epilepsy (JME) and idiopathic occipital lobe epilepsies. The overall prevalence of headache in children with epilepsy ranges from 8% to 15%, showing even higher values on the EEG, namely 63% in children presenting with centrotemporal spikes and 33% in children with absences. The term ictal epileptic headache has been recently introduced to describe the very rare clinical condition in which migraine/headache is the only symptom of an epileptic seizure. Although the comorbidity epilepsy/headache is frequent, epileptic migraine is very rare. Therefore, it is important to suspect, recognize and diagnose such a clinical case to avoid making wrong diagnosis and prescribing too many radiological tests. The correct diagnostic criteria suggested for ictal epileptic headache can help the clinician diagnose epileptic headache in children.