Skip to main content
PMC home page
The Journal of Headache and Pain logoLink to The Journal of Headache and Pain
. 2010 Oct 21;11(6):469–476. doi: 10.1007/s10194-010-0229-9

Headache, epilepsy and photosensitivity: how are they connected?

Dorothée G A Kasteleijn-Nolst Trenité 1, Alberto Verrotti 3, Alessia Di Fonzo 3, Laura Cantonetti 4, Raffaella Bruschi 2, Francesco Chiarelli 3, Maria Pia Villa 2, Pasquale Parisi 2,✉
PMCID: PMC3476223  PMID: 20963464

Abstract

Although headache and epilepsy have often been associated, the precise electroclinical and pathophysiological interaction between these disorders and in particular its relations with photosensitivity is as yet to be fully understood in adults or children. The association between headache and epilepsy commonly occurs in all types of epilepsy and not only in occipital epilepsy. Generally, peri-ictal headache is often neglected, regardless of its severity, because patients are more concerned about their seizures. Altered cerebral cortex excitability may be the link between these two conditions and photosensitivity shows this. The physician should bear this association in mind when dealing with epileptic and migraine patients so as to be able to offer such patients an accurate diagnosis and appropriate treatment; this should be borne in mind when declaring epileptic patients ‘seizure free’. To date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may, on occasion, be the sole ictal epileptic manifestation. Lastly, studies designed to investigate the triggering role of photosensitivity in both headache and epilepsy are warranted.

Keywords: Peri-ictal headache, Ictal epileptic headache, PPR, Photosensitivity, Headache, Migraine, Epilepsy, Migralepsy, Hemicrania epileptica

Full Text

The Full Text of this article is available as a PDF (193.5 KB).

Conflict of interest

None.

References

  • 1.Toldo I, Perissinotto E, Menegazzo F, Boniver C, Sartori S, Salviati L, Clementi L, Montagna P, Battistella PA. Comorbidity between headache and epilepsy in a pediatric headache center. J Headache Pain. 2010;11(3):235–240. doi: 10.1007/s10194-010-0191-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Fernández-de-Las-Peñas C, Hernández-Barrera V, Carrasco-Garrido P, Alonso-Blanco C, Palacios-Ceña D, Jiménez-Sánchez S, Jiménez-García R. Population-based study of migraine in Spanish adults: relation to socio-demographic factors, lifestyle and co-morbidity with other conditions. J Headache Pain. 2010;11(2):97–104. doi: 10.1007/s10194-009-0176-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Lipton RB, Ottman R, Ehrenberg BL, Hauser WA. Comorbidity of migraine: the connection between migraine and epilepsy. Neurology. 1994;44:28–32. [PubMed] [Google Scholar]
  • 4.Ottman R, Lipton RB. Comorbidity of migraine and epilepsy. Neurology. 1994;44:2105–2110. doi: 10.1212/wnl.44.11.2105. [DOI] [PubMed] [Google Scholar]
  • 5.Baulac S, Huberfeld G, Gourfinkel-An I. First genetic evidence of GABA(A) receptor dysfunction in epilepsy: a mutation in the gamma2-subunit gene. Nat Genet. 2001;28:46–48. doi: 10.1038/88254. [DOI] [PubMed] [Google Scholar]
  • 6.Andermann E, Andermann F. Migraine–epilepsy relationships: epidemiological and genetic aspects. In: Andermann FA, Lugaresi E, editors. Migraine and epilepsy. Boston: Butterworths; 1987. pp. 281–291. [Google Scholar]
  • 7.Marks DA, Ehrenberg BL. Migraine-related seizures in adults with epilepsy, with EEG correlation. Neurology. 1993;43:2476–2483. doi: 10.1212/wnl.43.12.2476. [DOI] [PubMed] [Google Scholar]
  • 8.Velioglu SK, Ozmenoglu M. Migraine-related seizures in an epileptic population. Cephalalgia. 1999;19:797–801. doi: 10.1046/j.1468-2982.1999.1909797.x. [DOI] [PubMed] [Google Scholar]
  • 9.Kwan P, Man CBL, Leung H, Yu E, Wong KS. Headache in patients with epilepsy: a prospective incidence study. Epilepsia. 2008;49:1099–1102. doi: 10.1111/j.1528-1167.2008.01574.x. [DOI] [PubMed] [Google Scholar]
  • 10.Schon F, Blau JN. Post-epileptic headache and migraine. J Neurol Neurosurg Psychiatry. 1987;20:1148–1152. doi: 10.1136/jnnp.50.9.1148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Yankovsky AE, Andermann F, Mercho S, Dubeau F, Bernasconi A. Preictal headache in partial epilepsy. Neurology. 2005;65:1979–1981. doi: 10.1212/01.wnl.0000188820.17776.cd. [DOI] [PubMed] [Google Scholar]
  • 12.Parain D, Guerrini R, Hesdorferr D, Ryvlin P (eds) (2009) Epilepsy and migraine. Current problem in epilepsy. John Libbey Eurotext, Paris
  • 13.Guerrini R, Genton P. Epileptic syndromes and visually induced seizures. Epilepsia. 2004;45(Suppl 1):14–18. doi: 10.1111/j.0013-9580.2004.451011.x. [DOI] [PubMed] [Google Scholar]
  • 14.Ferrie CD, Beaumanoir A, Guerrini R, et al. Early-onset benign occipital seizure susceptibility syndrome. Epilepsia. 1997;38(3):285–293. doi: 10.1111/j.1528-1157.1997.tb01119.x. [DOI] [PubMed] [Google Scholar]
  • 15.Panayiotopoulos CP. Visual phenomena and headache in occipital epilepsy: a review, a systematic study and differentiation from migraine. Epileptic Disord. 1999;1(4):205–216. [PubMed] [Google Scholar]
  • 16.Caraballo R, Cersósimo R, Fejerman N. Childhood occipital epilepsy of Gastaut; study of 33 patients. Epilepsia. 2008;49(2):288–297. doi: 10.1111/j.1528-1167.2007.01322.x. [DOI] [PubMed] [Google Scholar]
  • 17.Fejerman N, Caraballo R (2008) Benign focal epilepsies in infancy, childhood and adolescence. John Libbey Eurotext, Paris
  • 18.Caraballo R, Koutroumanidis M, Panayiotopoulos CP, Fejerman N. Idiopathic childhood occipital epilepsy of Gastaut: a review and differentiation from migraine and other epilepsies. J Child Neurol. 2009;24(12):1536–1542. doi: 10.1177/0883073809332395. [DOI] [PubMed] [Google Scholar]
  • 19.Parisi P, Kasteleijn-Nolst Trenité DG, Piccioli M, Pelliccia A, Luchetti A, Buttinelli C, Villa MP. A case with atypical childhood occipital epilepsy “Gastaut type”: an ictal migraine manifestation with a good response to intravenous diazepam. Epilepsia. 2007;48(11):2181–2186. doi: 10.1111/j.1528-1167.2007.01265.x. [DOI] [PubMed] [Google Scholar]
  • 20.Ghofrani M, Mahvelati F, Tonekaboni H. Headache as a sole manifestation in nonconvulsive status epilepticus. J Child Neurol. 2007;22(5):660–662. doi: 10.1177/0883073807303252. [DOI] [PubMed] [Google Scholar]
  • 21.Parisi P, Kasteleijn-Nolst Trenité DG. Commentary on ‘‘migralepsy’’: a call for revision of the definition. Epilepsia. 2010;51(5):932–933. doi: 10.1111/j.1528-1167.2009.02407.x. [DOI] [PubMed] [Google Scholar]
  • 22.Headache Classification Subcommittee of the International Headache Society The International Classification of Headache Disorders, 2nd edn. Cephalalgia. 2004;24(Suppl):1–160. doi: 10.1111/j.1468-2982.2003.00824.x. [DOI] [PubMed] [Google Scholar]
  • 23.Engel J, Jr, International League Against Epilepsy (ILAE) A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology. Epilepsia. 2001;42:796–803. doi: 10.1046/j.1528-1157.2001.10401.x. [DOI] [PubMed] [Google Scholar]
  • 24.Kasteleijn-Nolst Trenite DG. Photosensitivity in epilepsy Electrophysiological and clinical correlates. Acta Neurol Scand Suppl. 1989;125:3–149. [PubMed] [Google Scholar]
  • 25.Lennox WG, Lennox MA (1960) Epilepsy and related disorders. Little, Brown and Company, Boston, pp 582–587
  • 26.Panayiotopoulos CP. Differentiating occipital epilepsies from migraine with aura, acephalgic migraine and basilar migraine. In: Panayiotopoulos CP, editor. Benign childhood partial seizures and related epileptic syndromes. London: John Libbey & Company Ltd; 1999. pp. 281–302. [Google Scholar]
  • 27.Walker MC, Smith SJM, Sisodya SM, Shorvon SD. Case of simple partial status epilepticus in occipital lobe epilepsy misdiagnosed as migraine: clinical, electrophysiological, and magnetic resonance imaging characteristics. Epilepsia. 1995;36:1233–1236. doi: 10.1111/j.1528-1157.1995.tb01067.x. [DOI] [PubMed] [Google Scholar]
  • 28.Parisi P. Why is migraine rarely, and not usually, the sole ictal epileptic manifestation? Seizure. 2009;18:309–312. doi: 10.1016/j.seizure.2009.01.010. [DOI] [PubMed] [Google Scholar]
  • 29.Parisi P. Who’s still afraid of the link between headache and epilepsy? Some reactions to and reflections on the article by Marte Helene Bjørk and co-workers. J Headache Pain. 2009;10:327–329. doi: 10.1007/s10194-009-0149-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Piccioli M, Parisi P, Tisei P, Villa MP, Buttinelli C, Kasteleijn-Nolst Trenité DG. Ictal headache and visual sensitivity. Cephalalgia. 2009;29(2):194–203. doi: 10.1111/j.1468-2982.2008.01707.x. [DOI] [PubMed] [Google Scholar]
  • 31.Yankovsky AE, Andermann F, Mercho Sl, et al. Preictal headache in partial epilepsy. Neurology. 2005;65:1979–1981. doi: 10.1212/01.wnl.0000188820.17776.cd. [DOI] [PubMed] [Google Scholar]
  • 32.Schon F, Blau JN. Post-epileptic headache and migraine. J Neurol Neurosurg Psychiatry. 1987;50:1148–1152. doi: 10.1136/jnnp.50.9.1148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Karaali-Savrun F, Goksan B, Yeni SN, et al. Seizure-related headache in patients with epilepsy. Seizure. 2002;11:67–69. doi: 10.1053/seiz.2001.0583. [DOI] [PubMed] [Google Scholar]
  • 34.Forderreuther S, Henkel A, Noachtar S, et al. Headache associated with epileptic seizures: epidemiology and clinical characteristics. Headache. 2002;4:649–655. doi: 10.1046/j.1526-4610.2002.02154.x. [DOI] [PubMed] [Google Scholar]
  • 35.Bernasconi A, Andermann F, Bernasconi N, et al. Lateralizing value of peri-ictal headache: a study of 100 patients with partial epilepsy. Neurology. 2001;56:130–132. doi: 10.1212/wnl.56.1.130. [DOI] [PubMed] [Google Scholar]
  • 36.Cai S, Hamiwka LD, Wirrell EC. Peri-ictal headache in children: prevalence and characteristic. Pediatr Neurol. 2008;39:91–96. doi: 10.1016/j.pediatrneurol.2008.05.012. [DOI] [PubMed] [Google Scholar]
  • 37.Karaali-Savrun F, Goksan B, Yeni SNl, et al. Seizure related headache in patients with epilepsy. Seizure. 2002;11:67–69. doi: 10.1053/seiz.2001.0583. [DOI] [PubMed] [Google Scholar]
  • 38.D’Alessandro R, Sacquegna T, Pazzaglia P, Lugaresi E. Post-epileptic headache and migraine. J Neurol Neurosurg Psychiatry. 1988;51:596–597. doi: 10.1136/jnnp.51.4.596. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Leniger T, Isbruch K, Driesch S, Diener HC, Hufnagel A. Seizure-associated headache in epilepsy. Epilepsia. 2001;42:1176–1179. doi: 10.1046/j.1528-1157.2001.37500.x. [DOI] [PubMed] [Google Scholar]
  • 40.Ito M, Schachter SC. Frequency and characteristics of interictal headaches in patients with epilepsy. J Epilepsy. 1996;9:83–86. doi: 10.1016/0896-6974(96)00004-7. [DOI] [Google Scholar]
  • 41.Ogunyemi A, Adams D. Migraine-like symptoms triggered by occipital lobe seizures: response to sumatriptan. Can J Neurol Sci. 1998;25:151–153. doi: 10.1017/s0317167100033771. [DOI] [PubMed] [Google Scholar]
  • 42.Andermann F, Zifkin B. The benign occipital epilepsies of childhood: an overview of the idiopathic syndromes and of the relationship to migraine. Epilepsia. 1998;39:9–23. doi: 10.1111/j.1528-1157.1998.tb05129.x. [DOI] [PubMed] [Google Scholar]
  • 43.Panayiotopoulos CP. Elementary visual hallucinations, blindness and headache in idiopathic occipital epilepsy: differentiation from migraine. J Neurol Neurosurg Psychiatry. 1999;66:536–540. doi: 10.1136/jnnp.66.4.536. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Ito M, Adach N, Nakamura F, Koyama T, Okamura T, Kato M, Kanemoto K, Nakano T, Matsuura M, Hara S. Characteristics of postictal headache in patients with partial epilepsy. Cephalalgia. 2004;24:23–28. doi: 10.1111/j.1468-2982.2004.00628.x. [DOI] [PubMed] [Google Scholar]
  • 45.Ito M, Nakamura H, Honma H, Takeda Y, Kobayashi R, Miyamoto Tl, et al. Clinical factors associated with postictal headache in patients with epilepsy. Acta Neurol Scand. 2000;102:129–131. doi: 10.1034/j.1600-0404.2000.102002129.x. [DOI] [PubMed] [Google Scholar]
  • 46.Schachter SC, Richman K, Loder E, Belk S. Self-reported characteristics of postictal headaches. J Epilepsy. 1995;8:41–43. doi: 10.1016/0896-6974(94)00007-M. [DOI] [Google Scholar]
  • 47.Lauritzen M. Pathophysiology of the migraine aura. The spreading depression theory. Brain. 1994;117:199–210. doi: 10.1093/brain/117.1.199. [DOI] [PubMed] [Google Scholar]
  • 48.Panayiotopoulos CP (1987) Difficulties in differentiating migraine and epilepsy based on clinical EEG findings. In: Andermann F, Lugaresi E (eds) Migraine and epilepsy. Butterworths, Boston, pp 31–46
  • 49.Blume WT, Wiebe S (2000) Occipital lobe epilepsies. In: Williamson PD, Siegel AM, Roberts DW, Thadani VM, Gazzaniga MS (eds) Neocortical epilepsies. Advances in neurology. Lippincott/Williams & Wilkins, Philadelphia, pp 173–187 [PubMed]
  • 50.Pandya DN, Yeterian EH. Architecture and connections of cortical association areas. In: Peters A, Jones EG, editors. Cerebral cortex association and auditory cortices. New York: Plenum; 1985. pp. 3–62. [Google Scholar]
  • 51.Kasteleijn-Nolst Trenite DG, Binnie CD, Harding GF, Wilkins A. Photic stimulation: standardization of screening methods. Epilepsia. 1999;40(Suppl 4):75–79. doi: 10.1111/j.1528-1157.1999.tb00911.x. [DOI] [PubMed] [Google Scholar]
  • 52.Piccinelli P, Borgatti R, Nicoli F, et al. Relationship between migraine and epilepsy in paediatric age. Headache. 2006;46:413–421. doi: 10.1111/j.1526-4610.2006.00373.x. [DOI] [PubMed] [Google Scholar]
  • 53.Kasteleijn-Nolst Trenité DGA, Silva LCB, Manreza MLG.Prevalence of photo paroxysmal EEG responses in normal children and adolescents in Teofile Otoni, Brazil: 2001–2002 Epilepsia 200344Suppl 84812558833 [Google Scholar]
  • 54.Wendorff J, Juchniewicz B. Photosensitivity in children with idiopathic headaches. Neurol Neurochir Pol. 2005;39(4 Suppl 1):S9–S16. [PubMed] [Google Scholar]
  • 55.Fujita M, Fujiwara J, Maki T, Shigeta M, Shibasaki K, Takahashi N, Takahashi M. The efficacy of sodium valproate and a MRA finding in confusional migraine. Brain Dev. 2007;29(3):178–181. doi: 10.1016/j.braindev.2006.08.001. [DOI] [PubMed] [Google Scholar]
  • 56.Avraham SB, Har-Gil M, Watemberg N. Acute confusional migraine in an adolescent: response to intravenous valproate. Pediatrics. 2010;125(4):e956–e959. doi: 10.1542/peds.2009-2717. [DOI] [PubMed] [Google Scholar]
  • 57.Siniatchkin M, Groppa S, Jerosch B, et al. Spreading photoparoxysmal EEG response is associated with an abnormal cortical excitability pattern. Brain. 2007;130(Pt 1):78–87. doi: 10.1093/brain/awl306. [DOI] [PubMed] [Google Scholar]
  • 58.Bjørk MH, Stovner LJ, Nilsen BM, Stjern M, Hagen K, Sand T. The occipital alpha rhythm related to the “migraine cycle” and headache burden: a blinded, controlled longitudinal study. Clin Neurophysiol. 2009;120(3):464–471. doi: 10.1016/j.clinph.2008.11.018. [DOI] [PubMed] [Google Scholar]
  • 59.Sannita WG, Narici L, Picozza P. Positive visual phenomena in space: a scientific case and a safety issue in space travel. Vision Res. 2006;46(14):2159–2165. doi: 10.1016/j.visres.2005.12.002. [DOI] [PubMed] [Google Scholar]
  • 60.Beckmann YY, Seçil Y, Kendir AI, Başoğlu M. Chronic migraine: a prospective descriptive clinical study in a headache center population. Pain Pract. 2009;9(5):380–384. doi: 10.1111/j.1533-2500.2009.00305.x. [DOI] [PubMed] [Google Scholar]
  • 61.Syvertsen M, Helde G, Stovner LJ, Brodtkorb E. Headaches add to the burden of epilepsy. J Headache Pain. 2007;8(4):224–230. doi: 10.1007/s10194-007-0398-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Noseda R, Kainz V, Jakubowski M, Gooley JJ, Saper CB, Digre K, Burstein R. A neural mechanism for exacerbation of headache by light. Nat Neurosci. 2010;13(2):239–245. doi: 10.1038/nn.2475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63.Haglund MM, Schwartzkroin PA. Role of Na–K pump potassium regulation and IPSPs in seizures and spreading depression in immature rabbit hippocampal slices. J Neurophysiol. 1990;63:225–239. doi: 10.1152/jn.1990.63.2.225. [DOI] [PubMed] [Google Scholar]
  • 64.Deprez L, Peeters K, Paesschen W, et al. Familial occipitotemporal lobe epilepsy and migraine with visual aura. Linkage to chromosome 9q. Neurology. 2007;68:1995–2002. doi: 10.1212/01.wnl.0000262764.78511.17. [DOI] [PubMed] [Google Scholar]
  • 65.Castro MJ, Stam AH, Lemos C, et al. First mutation in the voltage-gated Nav1.1 subunit gene SCN1A with co-occurring familial hemiplegic migraine and epilepsy. Cephalalgia. 2009;29(3):308–313. doi: 10.1111/j.1468-2982.2008.01721.x. [DOI] [PubMed] [Google Scholar]
  • 66.Vanmolkot KR, Kors EE, Hottenga JJ, et al. Novel mutations in the Na+, K+-ATPase pump gene ATP1A2 associated with familial hemiplegic migraine and benign familial infantile convulsions. Ann Neurol. 2003;54:360–366. doi: 10.1002/ana.10674. [DOI] [PubMed] [Google Scholar]
  • 67.Goadsby PJ, Charbit AR, Andreou AP, Akerman S, Holland PR. Neurobiology of migraine. Neuroscience. 2009;161:327–341. doi: 10.1016/j.neuroscience.2009.03.019. [DOI] [PubMed] [Google Scholar]
  • 68.Parisi P, Piccioli M, Villa MP, Buttinelli C, Kasteleijn-Nolst Trenate DGA. Hypothesis on neurophysiopathological mechanisms linking epilepsy and headache. Med Hypotheses. 2008;70:1150–1154. doi: 10.1016/j.mehy.2007.11.013. [DOI] [PubMed] [Google Scholar]
  • 69.Koutroumanidis M. Panayiotopoulos syndrome: an important electroclinical example of benign childhood system epilepsy. Epilepsia. 2007;48:1044–1053. doi: 10.1111/j.1528-1167.2007.01096.x. [DOI] [PubMed] [Google Scholar]
  • 70.Bullmore E, Sporns O. Complex brain networks: graph theoretical analysis of structural and functional systems. Nat Rev Neurosi. 2009;10(3):186–198. doi: 10.1038/nrn2575. [DOI] [PubMed] [Google Scholar]
  • 71.Moskowitz MA, Nozaki K, Kraig RP. Neocortical spreading depression provokes the expression of C-fos protein-like immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. J Neurosci. 1993;13(3):1167–1177. doi: 10.1523/JNEUROSCI.13-03-01167.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Ayata C, Jin H, Kudo C, Dalkara T, Moskowitz MA. Suppression of cortical spreading depression in migraine prophylaxis. Ann Neurol. 2006;59(4):652–661. doi: 10.1002/ana.20778. [DOI] [PubMed] [Google Scholar]
  • 73.Berger M, Speckmann EJ, Pape HC, Gorji A. Spreading depression enhances human neocortical excitability in vitro. Cephalalgia. 2008;28:558–562. doi: 10.1111/j.1468-2982.2008.01556.x. [DOI] [PubMed] [Google Scholar]
  • 74.Calabresi P, Galletti F, Rossi C, Sarchielli P, Cupini LM. Antiepileptic drugs in migraine: from clinical aspects to cellular mechanisms. Trends Pharmacol Sci. 2007;28(4):188–195. doi: 10.1016/j.tips.2007.02.005. [DOI] [PubMed] [Google Scholar]
  • 75.Tommaso M, Guido M, Sardaro C, et al. Effects of topiramate and levetiracetam vs placebo on habituation of contingent negative variation in migraine patients. Neurosci Lett. 2008;442:81–85. doi: 10.1016/j.neulet.2008.06.076. [DOI] [PubMed] [Google Scholar]
  • 76.Kasteleijn-Nolst Trenité DGA, Cantonetti L, Parisi P (2010) Visual stimuli, photosensitivity and photosensitive epilepsy. Chapter 94. In: Shorvon S, Guerrini R, Andermann F (eds) Common and uncommon causes of epilepsy. Cambridge University Press, Cambridge (in press)

Articles from The Journal of Headache and Pain are provided here courtesy of BMC

RESOURCES