Ictal headache

1.Ictal epileptic headache (IEH) [2][4] or, more simply, Epileptic headache (EH, since the term "ictal" is pleonastic, as a headache manifestation of an epileptic seizure is by definition ictal).[3] This is a rare form of painful seizure.[3][7] EH may be the initial phase (so-called aura, necessarily with awareness) of an epileptic seizure, which then continues with other manifestations, for example convulsions. But EH is of greater clinical importance when it is an isolated event ("pure EH" [8]), i.e. not followed by other manifestations that clarify its epileptic nature.

Symptoms and diagnosis. EH has no clinical elements allowing a diagnosis. The characteristics and location of the pain in EH can be different: sometimes migraine-like with or without aura, sometimes tension-type, sometimes indefinable. The duration of an episode of EH may last for seconds, but even for days (headache/status epilepticus [9]).

For the diagnosis it is necessary to perform an EEG during the headache that shows epilepsy-compatible discharges coinciding with the onset and cessation of the headache.

The so-called hemicrania epileptica is a variant of EH characterized by the fact that head pain and EEG paroxysms are located on the same side.

MRI is necessary to establish the cause, which, as in all focal epilepsies, can be varied: malformations/dysplasia, neoplasms, encephalopathies, traumatic brain injury, vasculopathies.[3]

Therapy. It depends on the etiology. During the headache, like most seizures, i.v. benzodiazepines are usually effective. Antiepileptic drugs can be used as preventive.

2. Ictal non-epileptic headache. Rare cases are reported.[10] It is a condition that can be differentiated with certainty from the previous one if the headache episode is also present outside the seizure, that is, before and/or after, without specific EEG abnormalities.[5]