Headaches in parietal and occipital lobe epilepsy

The prevalence of headache in epilepsy patients is above average compared to the general population. This is especially true for patients with idiopathic generalized and parieto-occipital epilepsies. Comorbidity of both syndromes is suspected as the frequency of the joint occurrence of headache and epilepsy exceeds the statistical coincidence rate. This hypothesis is supported by data on shared genetic variants as well as overlapping pathophysiological mechanisms. Up to 62% of patients with parietal and occipital lobe epilepsy (POLE) report headaches. These occur especially following seizures (postictally) and with migraine-like or tension-type characteristics. Less frequently, headache manifests before (preictal), during (ictal) or between (interictal) epileptic seizures. The most relevant differential diagnoses for paroxysmal events with neurological deficits and accompanying headache are migraine and vascular events, such as syncope and transient ischemic attacks.