7.6 Headache attributed to epileptic seizure

Coded elsewhere:
There is a complex and bidirectional association between migraine and epilepsy. Where the two coexist, without either being a risk factor for the other, migraine is coded under 1. Migraine according to its subtype. Where migraine is comorbid with certain forms of epilepsy, such as benign occipital epilepsy, benign rolandic epilepsy and corticoreticular epilepsy with absence seizures, again it is coded under 1. Migraine according to its subtype. Where migraine-like or other headache and epilepsy are both part of a specific brain disorder (eg, MELAS), the headache is coded to that disorder. Where a seizure occurs during or immediately following a migraine aura (“migralepsy”), it is coded as 1.4.4 Migraine aura-triggered seizure.

Description:
Headache caused by an epileptic seizure, occurring during and/or after the seizure and remitting spontaneously within hours or up to three days.

Diagnostic criteria:
A. Any headache fulfilling criterion C
B. The patient is having or has recently had an epileptic seizure
C. Evidence of causation demonstrated by both of the following:

    1. headache has developed simultaneously with onset of the seizure
    2. headache has resolved spontaneously after the seizure has terminated

D. Not better accounted for by another ICHD-3 diagnosis.

Comment:
Pre-ictal headache has also been evaluated in a small study of 11 patients with intractable focal epilepsy. Headache was frontotemporal, ipsilateral to the focus in nine patients with temporal lobe epilepsy (TLE) and contralateral in one with TLE and one with frontal lobe epilepsy. More studies are needed to establish the existence of pre-ictal headache, and determine its prevalence and clinical features, in patients with partial and generalized epilepsy.