Association between Epilepsy and Headache: A Case Control Study

Aim: To study the prevalence of headache in patients with epilepsy and their first degree relatives as compared with controls.

Methods: Consecutive patients, older than 5 years, with active epilepsy attending the epilepsy clinic and their first-degree relatives were interviewed for the presence and type of headaches. Patients with mental retardation and communication difficulties were excluded. Type of headache was classified according to the International Headache Society Criteria III β. Control group included age- and sex-matched relatives of patients attending medicine outpatient clinics.

Results: A total of 120 patients (69 males), their first-degree relatives, and equal number of controls were studied from June to December 2018. Mean age of the patients was 26.5 ± 9.9 years and mean epilepsy duration was 10.3 ± 9.1 years. Of these, 76 (63.3%) had focal epilepsy and 40 (33.3%) had idiopathic generalized epilepsy. In the epilepsy group, 72 (60%) patients had interictal headache, 16 (13.3) had postictal headache, one (0.8%) had ictal headache, while nine (7.5%) patients had both interictal and postictal headaches. Interictal headache was present in 81 (67.5%) patients (25.8% migraine, 41.7% tension type headache [TTH]), 62 (51.6%) relatives (24.2% migraine and 27.5% TTH), and 51 (42.5%) controls (10.8% migraine and 31.7% TTH). All types of headaches (p = 0.0002) and migraine (p = 0.004) were more common in patients than control wile migraine was also more common in relatives as compared with controls (p = 0.01).

Conclusion: Migraine is more common in patients with epilepsy and their first-degree relatives as compared with controls indicating a shared genetic link between epilepsy and migraine.