| IHS | Diagnosis | ICD-10 |
|---|---|---|
| 7.6.2 | Post-ictal headache [G40.x or G41.x to specify seizure type] | G44.82 |
Diagnostic criteria
- Headache with features of tension-type headache or, in a patient with migraine, of migraine headache and fulfilling criteria C and D
- The patient has had a partial or generalised epileptic seizure
- Headache develops within 3 hours following the seizure
- Headache resolves within 72 hours after the seizure
Comments:
Post-ictal headache with migrainous features is a well-recognised consequence of a seizure discharge. Post-ictal headache is often indistinguishable from migraine headache and associated with nausea and vomiting. It is equally common in those with or without a family history of migraine. Other similarities with migraine headache are that, in some patients, post-ictal headache develops 3-15 minutes after the end of visual hallucinations (and it is longer and more severe after visual seizures of longer duration). Similar post-ictal headache has been reported in patients with symptomatic epilepsy but it is mainly emphasised in idiopathic occipital seizures. It may be that the seizure discharges in the occipital lobes trigger a genuine migraine headache through trigeminovascular or brainstem mechanisms.
In a study of 100 patients with epilepsy, post-ictal headache occurred in 51 and most commonly lasted 6-72 hours. Major seizures were more often associated with post-ictal headache than were minor attacks. Nine patients in this series also had migraine: in eight, a typical albeit mild migraine attack was provoked by seizures. Post-ictal headache in the 43 who did not develop migraine was accompanied by vomiting in 11 cases, photophobia in 14 cases and vomiting with photophobia in 4 cases. Furthermore, post-ictal headache was accentuated by coughing, bending and sudden head movements and relieved by sleep. It is, therefore, clear that seizures provoke a syndrome similar to the headache phase of migraine in 50% of epileptics.
