Clinical Analysis Of Headache In Patients With Epilepsy

Background and purposesEpilepsy is a clinical syndrome caused by the highly synchronized abnormal discharge of brain neurons followed by various reasons.It is a chronic disease with a course of several years or even decades.Long-term seizures will lead to a variety of comorbidities,such as epilepsy,headache,anxiety,depression and so on.After each seizure,patients often complained about headache,which is called post-icatal headache.The inter-ictal of seizures is often accompanied by headache.It is called interictal headache when seizures and headache attacks appear separately.The proportion of epilepsy comorbid headache has many different results,and it has been reported that epilepsy comorbid migraine is as high as 23.0%,or even higher.Epilepsy,migraine,and tension-type headache are all epilepsy diseases.They have the same predisposing factors and genetic susceptibility,indicating that their pathophysiological mechanisms may be similar.Therefore,many countries have carried out clinical and basic research about epilepsy comorbid headaches for many years.Evidence from genetics and animal experiments shows that both migraine and familial epilepsy have genetic variation and neuronal excitability abnormalities,including ion channel dysfunction,glutamatergic mechanism,and mitochondrial dysfunction.Patients with epilepsy are also prone to comorbid mental disorders and cognitive disorders.Among them,depression and anxiety are the most common psychological comorbidities,and comorbid headaches may further aggravate other comorbidities and cause adverse effects on patients.The prognosis seriously affects the quality of life of patients.Therefore,for epilepsy and headache comorbidities,when choosing anti-epileptic drugs,not only the type of seizure should be considered,but also possible mechanisms,comorbidities and other conditions should be considered.There are a small number of studies on the prevalence of epilepsy comorbid headaches,but their results are different,and no epidemiological studies have been seen.There are also reports on the clinical characteristics of epilepsy comorbid headaches.There is no report on whether epilepsy comorbid headaches,especially moderate and severe headaches,need to be used with antalgesic.In this study,through the collection and follow-up of the clinical features of epilepsy patients with comorbid headaches,we studied the prevalence of migraine and other types of headaches in patients with epilepsy and its related factors,and the impact of anti-epileptic therapy on headaches,with a view to improving epilepsy comorbidities.We hope make recommendations for the diagnosis and treatment of the disease.MethodsThis study prospectively registered a total of 498 epilepsy patients diagnosed and treated in the neurology clinic and ward of the First Affiliated Hospital of Zhengzhou Humanology from July 1,2020 to December 31,2020,and finally included 460 cases in the study.We collected the clinical manifestations of epilepsy and headache in detail,and the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD)and headache influence test(HIT)-6 scale Evaluation.202 patients with headache were divided into preictal headache group(n=5),postictal headache group(n=134)and interictal headache group(n=119)according to the relationship between headache and seizure.The third edition of the International Classification of Headache Disorders(ICHD)diagnostic criteria divides the interictal headache group into a migraine group(n=38)and a non-migraine group(n=81).A follow-up call will be conducted after a month.Postictal headaches are grouped by headache intensity,that is,VAS scores 1 to 3 are mild,4 to 6 are moderate,and 7 to 10 are severe.We sort out the relevant data,analyze the differences in related indicators between the groups,and explore the related factors of headache in patients with epilepsy.ResultsA total of 498 patients with epilepsy were registered in this study,and 460 were eventually included in the study,of which 45.2%were males(208/460)and 54.8%were females(252/460),with an average age of 35.2±12.4 years.1.Clinical features of headache in patients with epilepsyAmong 460 patients with epilepsy,211(45.9%)patients had headaches,of which 5 cases(1.1%)had preictal headache,134 cases(29.1%)had postictal headache,and 119 cases(18.9%)had interictal headache,including 47 cases(10.2%)suffering from postictal headache and interictal headache at the same time.Postictal headaches were divided into mild subgroup(36 cases,26.9%),moderate subgroup(93 cases,69.4%)and severe subgroup(5 cases,3.7%)according to headache intensity.Interictal headaches were divided into migraine subgroup(38 cases,8.3%),tension-type headache subgroup(41 cases,8.9%)and unclassified headache subgroup(40 cases,8.7%)according to the diagnostic criteria of ICHD-3.There were 5 cases of preictal headache,none of which were accompanied by migraine aura,which occurred 30min-8h before the seizure,with a median of 2h,and followed by the seizure.79.1%(110/139)of the preictal headache and postictal headache degree changed with the intensity of the seizure.When the degree of seizure was relieved,the headache was reduced or disappeared.The location of postictal headache was significantly more bilateral than unilateral(73.1%vs 26.9%).Most of the headaches were episodic,and only 2 cases were chronic migraine.Common causes of headache attacks include insufficient rest,fatigue,and emotional agitation.68.1%(81/119)of interictal headache occurred after the seizure,and only 26.9%(32/119)occurred before the seizure.2.Comparison of clinical characteristics of headache patients in each groupComparing the clinical characteristics of migraine group,non-migraine group and no headache group,women in the migraine group have an obvious predominance.Compared with the non-migraine group,patients in the migraine group had significant differences in headache complaint rate,taking analgesics,HIT-6 score and HIT-6 score after 3 months(all P values<0.05).The proportion of family history of headaches in the migraine group and non-migraine group was higher than that in the no-headache group,and the difference was statistically significant(all P values<0.05).The types of antiepileptic drugs used in the migraine group and the non-migraine group were more than those in the no headache group,and the difference was statistically significant(all P values<0.05).On the HAMA score and HAMD score,the migraine group was higher than the non-migraine group and the no-headache group,and the non-migraine group was higher than the no-headache group.The differences between the three groups were statistically significant(all P values<0.001).Conclusions1.It is high incidence of headache comorbid in epilepsy.2.Epilepsy comorbid headaches,especially migraine has a significant impact on patients’ mental state and daily life.3.After the patient’s epilepsy symptoms are controlled,the migraine can be improved accordingly.