Clinical Evaluation of Migraine and Other Seizure Related Headache in patients with Epilepsy

INTRODUCTION: Epilepsy and Migraine are the chronic disorders with recurrent neurological dysfunction associated with headache and autonomic, abdominal and psychotic features. In some patients it may be difficult to differentiate between migraine and the seizure episodes. Both are having comorbid symptoms and occurrence. Migraine patients can develop seizure and epileptics can have migraine attacks. Epileptologists proposed the hyperexcitabilty of the altered brain tissue, as the cause of seizure and migraine headache occurrence and vice versa. Enhanced hyperexcitability of cortical neurons and diminished threshold are the pathophysiological mechanisms enumerated in these conditions. Low magnesium in brain and the altered neurotransmitters are responsible for increased cortical excitability. Both the environmental as well as the genetic factors might cause these changes. AIMS AND OBJECTIVES OF STUDY: 1.To study the incidence of various headaches which can occur periictally and interictally in patients with known primary generalised epilepsy. 2.To evaluate the association of headache, with the seizure and its impact on the patient‟s lifestyle. METHODS AND MATERIALS: The present study had been conducted at Government Rajaji Hospital, Madurai Medical College, Madurai during the period between March 2012 and February 2013. I have obtained written consent from the patient, after explaining about the study in detail. I got the ethical committee clearance, for this study from Madurai Medical College, Madurai. The outpatients registered at the Epilepsy clinic, Government Rajaji Hospital, Madurai Medical college during a one year period between March 2012 and February 2013 were taken up for the study. The clinical details were obtained from the epilepsy clinicoutpatient register/case sheets and patient interviews with the help of the priorly prepared proforma.I have taken details on demographic profile, seizure history and treatment history by interviewing the patient and from the case history with the help of standard questionnaire. I have asked the patients, torecord the seizure and headache occurrence details in a diary. Associated symptoms, as well asprecipitating factors for the headache will be noted by them.The diary will be scrutinized monthly during the period of the survey. Headache Impact Test (HIT-6) would be done to assess the headache impact in patient's daily life. RESULTS: In the present study which was conducted over 1year observation period, totally 248 patients (out of 300 recruited) completed the study and they were analysed . Their mean age was 36.30years and 123 (49.60%) of them were female, and 125 were male (50.40%) (Table 1). Average duration of seizure disorder was 6. 52 yrs. The total number of patients developed headache was 72 (29%) and without headache was 176 (70.97%) (Table 2). Of the 72 patients developed headache, 27 were male and 45 were female patients.(Table 3). Among the 72 (29%) patients with headache,54 (21.7%) patients developed headache in the interictal period and 10 (4.03%) in the periictal period and 8 (3.22%) patients developed headache both in the periictal as well as in the interictal period (Table 4). 27 (10.9%) Patients had developed migraine type of headache and 20 (8.06%) patients had tension type headache and 25 (10.08%) patients developed nonspecific headache. In the present study, this reveals that migraine is the most common type of headache in patients suffering from epilepsy. In the interictal period, 21 patients developed tension type of headache and 17 had developed migraine headache & 16 patients developed tension type of headache. This showed that patients with nonspecific headache predominates in the interictal period.(Table 5). CONCLUSION: 1. The present study showed the incidence of headache among the epileptic patients and its impact on their daily life. 2. In the present study, the headache incidence increases with the seizure frequency, which reiterates the fact that, adequate seizure control is essential to reduce the incidenceof headache inpatients with epilepsy. 3. Headache incidence in epileptic patients can be considerably ameliorated by choosing appropriate drug that will be useful for both seizure and headache. 4. This study demonstrates (HIT score) that seizure related headache is a common accompanying symptom of seizure, causes major impairment in daily life. Hence, by reducing the incidence of headache, we can improve the quality of life in patients with epilepsy. 5. This study also suggests that migraine is a frequent comorbid disorder in patients with epilepsy and an important factor which affects the occurrence and type of seizure related headache. 6. The links between the epilepsy, seizure related headache and migraine are an important subject for future investigation