In patients with epilepsy, post-ictal headaches (PIH) are associated with drug-resistant epilepsy, generalized seizures, and a family history of migraine; these three factors represent significant predictors of PIH in this population, according to study results published in Seizure.

The goal of this study was to analyze the clinical predictors of PIH in patients with epilepsy. Study researchers from Brazil followed 302 patients with newly diagnosed epilepsy for a mean of 9.8 years. Patients were recruited from a single university hospital in Brazil.

At diagnosis, the mean age of this cohort was 16.6 years (standard deviation, ±8.9 years). Patients were seen every 6 months (or more frequently as needed), and each patient attended an average of 24.7 visits. At each visit, neurologists applied structured questionnaires to ascertain information about patients’ headaches. Additionally, medical records were reviewed during follow-up. The primary outcome was the presence of PIH.

Continue Reading

About 46.3% of the patients in this study reported post-ictal headaches. These were diagnosed by a headache specialist neurologist when they were caused by and occurred within 3 hours after an epileptic seizure, and were spontaneously remitting within 72 hours following the end of the seizure.

55% of patients had tension-type post-ictal headache, 32.1% had the migrainous type, and 12.8% had both types. Significant predictors of PIH, according to multilevel linear modeling, included having a family history of migraine (odds ratio [OR], 1.696; 95% CI, 1.372-2.096; P =.032), having a diagnosis of drug-resistant epilepsy (OR, 1.169; 95% CI, 1.135-2.146; P =.029), months since last visit (OR, 1.464; 95% CI, 1.243-2.888; P =.035), and having generalized seizure onset type of epilepsy (OR, 1.527; 95% CI, 1.114-1.668; P =.004).

Limitations of this study included its hospital-based observational design, the inability to objectively test clinical responses of PIH of participants to different drugs, and the relatively small number of patients in the final sample.

Based on these findings, study researchers added that “patients with epilepsy could be benefited if they were more frequently asked about the occurrence of PIH since this is a neglected condition in many cases.”


Caprara F, Letícia A, Rissardo JP, et al. Characteristics of post-ictal headaches in patients with epilepsy: A longitudinal study. Seizure. Published online August 26, 2020.doi:10.1016/j.seizure.2020.08.001