Comorbidity headache and epilepsy in childhood

Rationale: Epilepsy and headache are both frequent in childhood. Because seizures are frequently a frightening event, other medical conditions - including headache - are often neglected not only by the patient, but also by the physician. The objective of this study was to verify the comorbidity between headache and epilepsy in childhood. Methods: This was a prospective study conducted at the pediatric epilepsy clinic of our university hospital. Fifty children with epilepsy and ability to describe their symptoms, between 5 and 18 years old, were interviewed according to a semi-structured questionnaire. The headache was classified according to the International Headache Society. The frequency of headache was compared with the findings of a control group composed by children without epilepsy, siblings of children with epilepsy. Results: Fifty children were evaluated, 29 boys, mean age 11 years. Twenty-three (46%) patients presented with headache, as opposed to only 1 (2.5%) in the control group (p<0.01). Ten (43.5%) had migraine, 4 (17.4%) had tension type headache and in 9 (39.1%) the type of headache could not be established. In 9/23 (39%) a temporal relationship between headache and epilepsy was present, 6 postictal and 3 preictal. There was no difference in gender, age, type of seizure and family history of headache in the groups of patients with or without headache. However, most patients with headache were older than 10 years (54.5%) and had idiopathic epilepsy (65.2%; p < 0.01). The headache usually started in the same year or after the diagnosis of epilepsy (95%; p < 0.01). Conclusion: Headache and epilepsy are a common comorbidity in childhood, and occur mostly in children older than 10 years with idiopathic epilepsy. The headache usually starts in the same year or after the diagnosis of epilepsy.