Ictal Epileptic Headache: When Terminology Is Not a Moot Question

Area of Science:

• Neurology
• Epileptology
• Headache Medicine

Background:

• The association between headache and epilepsy is complex and not fully understood.
• The concept of ictal epileptic headache (IEH) has emerged, aiming to classify headaches occurring during epileptic seizures.
• Current diagnostic classifications, including the International Classification of Headaches Disorders 3rd edition (ICHD-3), present challenges in defining and diagnosing IEH.

Purpose of the Study:

• To emphasize the importance of strictly applying the original 2012 diagnostic criteria for ictal epileptic headache (IEH).
• To clarify diagnostic confusion stemming from the non-inclusion of IEH criteria in the 2018 ICHD-3 revision.
• To analyze the clinical, historical, epidemiological, and pathophysiological characteristics of IEH.

Main Methods:

• Review and analysis of clinical, historical, epidemiological, and pathophysiological data related to IEH.
• Discussion of the neurophysiopathological links between epilepsy and headache.
• Examination of the classification of epileptic events as 'autonomic seizures'.

Main Results:

• The original IEH diagnostic criteria proposed in 2012 were restrictive, potentially leading to underdiagnosis.
• The exclusion of these criteria from the ICHD-3 (2018) has created significant confusion among clinicians and researchers.
• Analysis supports the distinctiveness of IEH and the need for clear diagnostic guidelines.

Conclusions:

• Strict adherence to the original IEH criteria is essential for accurate diagnosis and research.
• Further research is needed to elucidate the neurophysiopathological mechanisms connecting epilepsy and headache.
• Clarification of IEH classification is necessary to improve patient care and advance the field.