Neuro

J Headache Pain (2010) 11:235–240 DOI 10.1007/s10194-010-0191-6

ORIGINAL

Comorbidity between headache and epilepsy in a pediatric headache center
Irene Toldo • Egle Perissinotto • Francesca Menegazzo • Clementina Boniver • Stefano Sartori • Leonardo Salviati • Maurizio Clementi • Pasquale Montagna Pier Antonio Battistella
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Received: 16 October 2009 / Accepted: 12 January 2010 /Published online: 29 January 2010 Ó Springer-Verlag 2010

Abstract The purpose of this study was to analyse the comorbidity between headache and epilepsy in a large series of children with headache (1,795). Fifty-six cases (3.1%) suffered from idiopathic headache and idiopathic or cryptogenic epilepsy or unprovoked seizures. There was a strong association between migraine and epilepsy: in migraineurs(46/56) the risk of epilepsy was 3.2 times higher when compared with tension-type headache, without significant difference between migraine with and without aura (P = 0.89); children with epilepsy had a 4.5-fold increased risk of developing migraine than tension-type headache. In cases with comorbidity, focal epilepsies prevailed (43/56, 76.8%). Migraineurs affected by focal epilepsies (36/56) hada three times higher risk of having a cryptogenic epilepsy (27/36, 75%) than an idiopathic epilepsy (9/36, 25%) (P = 0.003). In migraine with aura, epilepsy preceded migraine in 71% of cases. Photosensitivity (7/56, 12.5%) and positive family history for epilepsy (22/56, 39%) were frequent in cases with comorbidity. Keywords Headache Á Migraine Á Epilepsy Á Comorbidity Á Children

IntroductionMigraine and epilepsy are both common neurological disorders, although migraine is more frequent, and can occur as comorbid conditions [1–6]. An association between migraine and epilepsy has been demonstrated in several studies, mainly based on adults affected by epilepsy [1, 5, 6]. In children an association between migraine and some epilepsy syndromes has been reported, but data are conflictingand studies have been limited by the small numbers of patients and to the lack of clearly stated diagnostic criteria of childhood migraine [7]. The growing knowledge of the genetic bases of familial hemiplegic migraine (FHM) [8] and the findings of epileptic seizures occurring independent of the migraine attacks in FHM families [9] have stimulated the interest on the comorbidity between migraine andepilepsy. The purpose of this study was to analyse the comorbidity between headache and epilepsy in a large series of children and to find out possible correlations among the type of headache, the type of epilepsy of probands and the family history for headache and epilepsy.

Methods
I. Toldo (&) Á F. Menegazzo Á C. Boniver Á S. Sartori Á L. Salviati Á M. Clementi Á P. A. Battistella Departmentof Pediatrics, University of Padova, Padua, Italy e-mail: irene.toldo@unipd.it E. Perissinotto Department of Preventive Medicine and Public Health, University of Padova, Padua, Italy P. Montagna Department of Neurological Sciences, University of Bologna, Bologna, Italy

This is a retrospective case–control study of 1,795 patients under 18 years of age consecutively diagnosed as affected byheadache at the pediatric Headache Center of the Department of Pediatrics of Padua Hospital between 1995 and 2008. We reviewed the medical records of all 1,795 patients, which contain pre-established questions concerning family and personal history of headache, and past medical history, which includes a section on seizures and epilepsy. From the total study population, we identified 56

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236J Headache Pain (2010) 11:235–240 Table 1 Clinical characteristics of our population N Sex Male Female Total Migraine MO MA Male to female ratio (M/F) Tension type ETTH CTTH Male to female ratio (M/F) Other headache types Other primary headaches Headache attributed to psychiatric disorder Secondary headaches Seizures Cases selecteda
a

patients with a diagnosis of idiopathic headache...