A Study of the Relationship between Headache and Epilepsy in Childhood

Park, So Hyeon; Chung, Hee Jung

Abstract

PURPOSE
Headache, especially migraine disorders, have been thought to be pathophysiologically related to epilepsy. We sought to elucidate the differential diagnostic clues between headache and epilepsy by analyzing the clinical characteristics of patients who presented with a chief complaint of headache and who had been subsequently diagnosed with epilepsy.
METHODS
We studied 399 patients with headache who had been followed-up in Pediatrics Department of Ilsan Hospital from January 2005 to July 2009. Patients were divided into two groups and analyzed retrospectively. The test group included 15 patients who had been diagnosed with epilepsy. The control group included 305 patients whose symptoms had been diagnosed as primary headache. We compared the type of headache, presence of aura, subtype of aura, family history of migraine disorders, EEG findings, and response to a hyperventilation test between the two groups.
RESULTS
305 patients had primary headache, 20 patients secondary headache, and 74 patients unclassified headache. Between the two groups, there was no statistically significant difference in mean age, sex, type of headache (P=0.23), type of aura (P=0.64), or associated family history (P=0.84). However the epilepsy group had more migraine with aura (P<0.05), more EEG abnormalities (P<0.0001), and more abnormal hyperventilation test (P<0.0001), which were all statistically significant.
CONCLUSION
The presence of aura, probably visual aura, and EEG abnormalities or abnormal response in hyperventilation test are very useful differential diagnostic clues for epilepsy in headache patients. Therefore, we highly recommend that EEG are performed in order to rule out the possibility of epilepsy in those children who present with headache and have migraine headache with aura and abnormal result on hyperventilation test.