Migraine Type Headache Research Articles

Comparison of plasma lipid peroxidation between migraine and tension type headache in Iraqi patients.

The oxidant-antioxidant balance disorders underlie a number of acute and chronic diseases of the centralnervous system (CNS). It is believed that oxidative stress plays a role in the pathogenesis of migraine. Thestudy objective is to assess the processes of lipid peroxidation with malondialdehyde (MDA) as its majorindicator. The study was carried out on Iraqi patients to estimate the level of lipid peroxidation in three groupsinclude control group (41subjects), tension-type headache (TTH) (41patients) and migraine (31patients). Themigraine, TTH, and control groups were significantly different on the measures of MDA. The study showedthat the migranieurs were significantly different from other two groups with respect to MDA (p 0.05). The onlysignificant difference between females’ age-groups was reported between (15-27years) and (28-40years) yearsold-groups (according to Games-Howell test (P=0.013) while Tukey HSD and Dunnett test contradicted theexits of any differences between them (P>0.05). According to the major similarity between aged-groups forboth males and females in the three groups, it can be concluded that MDA level is not affected by age.

57-Year-Old Man With Vertigo

57-Year-Old Man With Vertigo

Sensory Processing Difficulties Correlate With Disease Severity and Quality of Life Among Children With Migraine.

Introduction: Headaches are common among children and about 80% of children reporting them. Migraine and tension type headaches are the most common primary headaches in children and the prevalence of migraine is about 8%. Accompanying sensory symptoms are common before, during and after migraine attacks. They may be a part of a wider symptom constellation called sensory processing disorder or difficulties (SPD). This includes both hyper or hypo sensitivity to sensations. However, the literature regarding sensory processing symptoms of children and youth with headaches as well as its interaction with child's emotional aspects and quality of life is scarce.Materials and Methods: One hundred and thirty-four children between the ages of 8 and 12 participated in this study. Fifty-four children (22 boys and 32 girls) with episodic migraine were prospectively recruited from pediatric neurological clinics during the years 2014–2017. The control group included 80 healthy children. Both groups completed a health and demographic questionnaire, headache assessment including Ped-MIDAS, Short Sensory Profile, State-Trait Anxiety Inventory (STAI) for children, and the Pediatric Quality of Life Inventory.Results: Children with migraine showed significantly higher prevalence of sensory processing difficulties and lower quality of life compared to healthy controls. Among children with migraine, sensory processing difficulties significantly correlated with lower quality of life. Headache-related disability and sensory processing difficulties predicted quality of life.Conclusion: The possible relationship between migraine and sensory processing disorder or difficulties stresses the need to screen for sensory processing difficulties among children with migraine and when found—refer to their impacts on children's daily function and quality of life.

An evaluation of eating attitudes in patients with migraine and tension type headache

Objective: The aim of the study was to examine eating attitudes in patients with migraine and tension type headache. Methods: The study included 89 patients diagnosed with migraine according to the International Headache Society (IHS) 2004 criteria, 87 patients with tension type headache and 89 healthy volunteers matched in terms of age, gender and education level. A detailed neurological examination was made of all the participants and the Eating Attitudes Test (EAT), the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were applied. Results: In the comparisons of the EAT points, 23 of the tension type headache group and 18 of the migraine group were in the EAT ≥ 30 group, which was a statistically significantly higher rate compared to the control group (p = 0.099). The mean BDI points and the mean BAI points of both the migraine and the tension type headache groups were statistically significantly higher than those of the control group (p = 0.001 and p = 0.002, respectively). Conclusions: The results showed impairment in the eating attitudes of patients with migraine and tension type headache compared to the control group. When it is considered that some foodstuffs trigger headaches, eating disorders or impaired attitudes to eating become important.

PND73 DIFFERENTIATION OF EPISODIC MIGRAINE AND CHRONIC MIGRAINE USING A MACHINE LEARNING TECHNIQUE

Chronic migraine (CM) and episodic migraine (EM) are part of the spectrum of migraine disorders, but they are distinct clinical entities. EM is characterized as up to 14 migraine days per months, while CM is defined as 15 or more headache days per months, at least 8 out of which have to be typical migraine headache days. We seek to use a machine learning technique to produce the classification hence infer the severity of the disease. The diagnosis codes in the MarketScan database were used to produce three cohorts containing CM, EM and non-headache patients (a negative control group). Features were derived and a list of supervised machine learning algorithms were explored including random forest, neural networks, gradient boost, and stacked model. Particle swarm optimization algorithm was applied to explore the optimal parameters of the machine learning algorithms. 395 features were constructed. Each CM, EM or negative control group had 18,832 patients. The gradient boost algorithm produced the best result, which reported the accuracy and kappa at 0.75 and 0.63, respectively. After applying thresholds in the optimized gradient boost model, the accuracy and kappa were further increased to 0.81 and 0.72 with prediction decision made to 80% of the dataset. Collinearity and high correlation were found with features within the group regarding cost, resource, and medication use. 27% of CM and 9% of EM patients received wrong predictions from the fine-tuned random forest, gradient boost, and neural network. Migraine-related costs were ranked as top important features. Migraine patients with higher cost, resource use and medications use were more likely to have a diagnosis of CM vs EM, with higher migraine-related costs as the top indicators of a patient having CM. Further research on a data source with more migraine specific clinical outcomes is deemed.

Do you really have sinus headache?

<p class="abstract"><strong>Background:</strong> Headache is a common symptom. Correct diagnosis of the etiology is the key to successful treatment. Chronic headache are misdiagnosed as sinus headache because of presence of overlapping symptoms leading to unnecessary treatment with no relief to the patient. We decided to undertake this study with the objective of evaluating patients with chronic headache for presence of chronic rhinosinusitis and hence assess the contribution of sinus headache to chronic headache.</p><p class="abstract"><strong>Methods:</strong> The present study was conducted at Adichunchanagiri Institute of Medical Sciences, BG Nagara during the period January 2018 to December 2018. Patients presenting to OPD with chronic headache previously diagnosed as sinus headache were included in the study. A total of 174 patients were studied. All patients underwent detailed history taking, detailed ENT examination, and diagnostic nasal endoscopy. AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headache were used for diagnosis. </p><p class="abstract"><strong>Results:</strong> We found that only 13% (n=23) cases had chronic rhinosinusitis and hence diagnosed as sinus headache. 53% (n=92) had migraine, 31% (n=54) had tension type headache and 3% (n=5) could not be categorized.</p><p class="abstract"><strong>Conclusions:</strong> Prevalence of sinus headache in our study was found to be 13%. There are high chances of misdiagnosing chronic headache as sinus headache because primary forms of headache can present with nasal symptoms. The AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headaches are very useful and effective in making an accurate diagnosis.</p>

Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis

Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches. Databases PubMed (Medline), EMBASE, CINAHL, SCOPUS, and Web of Science were searched from inception to December 2018. Observational studies using a comparator group were included. Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Results were pooled using random effects meta-analysis. Level of evidence for each outcome was assigned based on risk of bias, consistency of results and magnitude of difference between participants with headache and controls. (PROSPERO registration: CRD42018083683). Of 48 studies included, the majority were rated moderate risk of bias due to possible confounding influences. In total, 17 cervical outcomes were assessed, with confidence in findings ranging from very low to moderate levels. Compared to controls, participants with TTH had greater forward head posture (FHP) (MD = -6.18°, 95% CI [-8.18°, -4.18°]) and less cervical range of motion (ROM) (greatest difference transverse plane MD = -15.0°, 95% CI [-27.7°, -2.3°]. Participants with migraine demonstrated minimally reduced cervical ROM (greatest difference sagittal plane MD = -5.4°, 95% CI [-9.9°, -0.9°]. No differences presented in head posture, strength, craniocervical flexion test performance or joint position error between migraineurs and controls. TTH presented with more findings of cervical musculoskeletal impairments than migraine however levels of confidence in findings were low. Future studies should differentiate episodic from chronic headache, identify coexisting musculoskeletal cervical disorders, and describe neck pain behaviour in headache.

Relationship between psychiatric comorbidity and quality of life in patients with migraine and tension type headache: preliminary report

Amaç: Bu çalışmanın amacı başağrısı olan hastalardaki psikiyatrik yüke de dikkat çekerek yaşam kalitesinin ve işlevselliğin nasıl etkilendiğini araştırmaktır.Gereç ve Yöntem: Sağlık Bakanlığı Üniversitesi Erenköy Ruh ve Sinir Hastalıkları Hastanesi Nöroloji Kliniği Baş ağrısı Özel Dal Polikliniği’ne Uluslararası Başağrısı Bozukluklarının Sınıflandırması (International Classification of Headache Disorders) ICHD-II’ye göre migren ve gerilim tipi baş ağrısı tanısı konmuş ardı sıra 100 hasta örneklem grubunu oluşturarak çalışmaya dahil edildi. Hastalara Veri Toplama Formu, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I Ölçeği) ve Short Form (Yaşam Kalitesi Ölçeği) (SF-36 ) uygulandı. Bulgular: Baş ağrısı hastalarının tümü değerlendirildiğinde %56’sında fiziksel hastalık, %94’ünde, özgeçmişinde psikiyatrik hastalık, %73’ünde ailede psikiyatrik hastalık saptandı. Migren hastaları ‘Geçen hafta içinde kaç gün kendinizi iyi hissettiniz?’ sorusunda ortalama 3.5±1.9 gün şeklinde yanıt verirken, gerilim tipi hastalar ortalama 3.5±1.7 gün yanıtını vermişlerdir. Migren hastaları şikayetleri sebebi ile ortalama 1.3±1.7 gün işe gitmezken, gerilim tipi hastaları ortalama 1±1.2 gün işe gitmemiştir.Sonuç: Başağrısı depresyon, anksiyete bozukluğu, analjezik kötüye kullanımı, kişilik bozuklukları ve bipolarite gibi komorbid psikiyatrik hastalıklarla sık birliktelik gösterir ve etkin psikiyatrik tedavi yapılmadığında ağrı kronikleşerek işlevsellik kaybına ve hayat kalitesinin düşmesine neden olur. Bu sebeple baş ağrısına yaklaşım multidisipliner olmalıdır.

Migraine and Episodic Tension Type Headache in School Children: Prevalence and Comparative Clinical Findings

Migraine and Episodic Tension Type Headache in School Children: Prevalence and Comparative Clinical Findings

The prevalence of primary headache disorders in the adult population of Estonia

To estimate the one-year prevalence of primary headaches, most importantly migraine and tension type headache, but also other primary headaches, in Estonia. A population-based random sample of 2162 subjects in Tartu City and Tartu County were interviewed by telephone or face to face using a previously validated questionnaire. Of the 2162 contacted participants, 1215 (56%) fully completed the study. Of these, 502 (41.3%) reported headache during the previous year. The prevalences adjusted by weighting by age, gender, education, marital status and habitat were the following: All headaches 41.0%, all migraine 17.7%, all tension-type headache 18.0%, trigeminal autonomic cephalalgias 0.4%, other primary headaches 2.5%, and chronic headaches 2.7%. The 1-year prevalences of primary headache disorders in Estonia are comparable to the previous findings in other European countries.

Protocolo diagnóstico de los dolores faciales y nucales

Facial and nuchal pain are caused mostly (90%) by structural causes (visceral pain), like glaucoma, sinusitis, odontalgia, cervicopathies, etc., and primary headaches syndromes, mainly migraine and tension type headache. Nevertheless, rarely conditions, some of them potentially dangerous, have to be taken into account (arterial dissection, trigeminal-autonomic cephalalgias, Chiari malformation, temporary arteritis, temporomandibular joint dysfunction, etc.). Finally, 10% of this type of pain is neuropathic, being mainly related to trigeminal and occipital neuralgias. However, terminal branch neuralgias of the trigeminal nerve, glossopharyngeal neuralgia, or persistent idiopathic facial pain have to be considered too. Herein, a diagnosis approach for mainly facial and nuchal pains is performed. Differential diagnosis is also developed.

Fibromuscular Dysplasia: Recognition and Management

Abstract Fibromuscular dysplasia is a noninflammatory, nonatherosclerotic disease that results in fibrous tissue buildup of the medium-sized arteries. Areas of stenosis and dilation in the arteries can result in dissection or aneurysm. The stenotic areas of the vessel alternating with dilation result in what is often described as a “string of beads” appearance on imaging. Symptoms depend on location and severity of the disease. Common symptoms include migraine-type headache, flank pain, and pulsatile tinnitus. This article describes the identifying characteristics of fibromuscular dysplasia, stresses the importance of recognition and referral, and provides the nurse practitioner with information to guide the differential diagnosis.

Self-medication for migraine: A nationwide cross-sectional study in Italy.

Headache disorders are considered the second leading cause of years lived with disability worldwide, and 90% of people have a headache episode at least once a year, thus representing a relevant public health priority. As the pharmacist is often the first and only point of reference for people complaining of headache, we carried out a survey in a nationwide sample of Italian pharmacies, in order to describe the distribution of migraine or non-migraine type headaches and medicines overuse among people entering pharmacies seeking for self-medication; and to evaluate the association, in particular of migraine, with socio-demographic and clinical characteristics, and with the pathway of care followed by the patients. A 14-item questionnaire, including socio-demographic and clinical factors, was administered by trained pharmacists to subjects who entered a pharmacy requesting self-medication for a headache attack. The ID Migraine™ Screener was used to classify headache sufferers in four classes. From June 2016 to January 2017, 4424 people have been interviewed. The prevalence of definite migraines was 40%, significantly higher among women and less educated people. About half of all headache sufferers and a third of migraineurs do not consider their condition as a disease and are not cared by any doctor. Among people seeking self-medication in pharmacies for acute headache attacks, the rate of definite or probable migraine is high, and a large percentage of them is not correctly diagnosed and treated. The pharmacy can be a valuable observatory for the study of headaches, and the first important step to improve the quality of care delivered to these patients.

Development and validation of a telephone classification interview for common chronic headache disorders

BackgroundFor a trial of supportive self-management for people with chronic headache we needed to develop and validate a telephone classification interview that can be used by a non-headache specialist to classify common chronic headache types in primary care. We aimed to specifically: exclude secondary headaches other than medication overuse, exclude primary headache disorders other than migraine and tension type headache (TTH), distinguish between chronic migraine and chronic TTH, and identify medication overuse headache.MethodsWe held a headache classification consensus conference to draw on evidence and expertise to inform the content of a logic model underpinning the classification interview. Nurses trained to use the logic model did telephone classification interviews with participants recruited from primary care. Doctors specialising in headache did a second validation interview.ResultsTwenty-six delegates attended the headache classification conference including headache specialist doctors, nurses and lay representatives (with chronic headache). We trained six nurses to do the classification interviews and completed 107 paired interviews, median days between interviews was 32 days (interquartile range 21–48 days). We measured level of agreement between the nurse and doctor interviews using proportion of concordance, simple kappa and prevalence-adjusted bias-adjusted kappa (PABAK). Proportion of concordance of agreement between nurse and doctor interviews was 0.76, simple kappa coefficient κ 0.31 (95% CI, 0.09 to 0.52), and PABAK 0.51 (95% CI, 0.35 to 0.68), a moderate agreement. In a sensitivity test following review of headache characteristics recorded, concordance was 0.91, κ = 0.53 (95% CI, 0.28 to 0.79), and PABAK = 0.81 (95% CI, 0.70 to 0.92), a very good agreement.ConclusionWe developed and validated a new evidence-based telephone classification interview that can be used by a non-headache specialist to classify common chronic headache types in primary care.

The Effectiveness of Diet Restriction in Elderly with Migraine.

Introduction:Migraine type headache is a type of pain with a high socioeconomic burden that limits the activities of daily life of individuals of all ages. The pathogenesis is not fully understood. There are a lot of migraine’s trigger factors and foods are one of them. The purpose of this study was to specify the effect of migraine triggering on the migraine attacks prevention in the elderly population.Method:The study consisted of patients over the age of 65 with a diagnose of migraine without aura according to International Headache classification. Thirty-one migraine patients with migraine attacks were included in the study. Triggering foods were expelled from the diets of migraine patients. This diet and pre-diet 2 months after the application, the frequency of attack within a month, attack duration and visual analog scale (VAS) pain intensity, the number of analgesics and triptans used were recorded.Results:A total of 31 patients (8 male and 23 female) were evaluated. In the second month after dieting, the frequency of attack, attack duration, pain severity, and analgesic and triptan counts were statistically significantly lower than the pre-treatment level (p<0.05).Conclusion:Results of the study; In migraine-aged elderly patients, it can be concluded that migraine attacks may be an effective and reliable treatment in reducing the number of analgesics and triptans used in migraine attacks.

Headaches and their relationships to epileptic seizures

PurposeThe frequent association between headache and epilepsy has been increasingly studied in recent years. Through this study, we attempted to study possible temporal associations between epileptic seizures and headaches. We also tried to describe clinical aspects of headache in our patients with epilepsy. Patients and methodsWe included patients with epilepsy and patients without epilepsy who presented for a first neurologic episode suggestive of epileptic seizure or unusual headache. These patients were invited to answer a standardized questionnaire screening for headache characteristics. Patients with epilepsy were asked for further data about their epilepsy. Electroencephalogram (EEG) was performed in all patients. Brain Magnetic resonance imaging MRI was reserved for patients in whom we suspected a structural lesion. ResultsOverall, we included 47 patients with a mean age of about 39 ± 15 years (19 to 68 years old) and a female predominance (Sex Ratio: SR = 1.47). Most frequently, our patients documented periictal headache (Peri-IH) (85.1%) including respectively ictal headache (IH: 31.9%); postictal headache (Post-IH: 21.3%), and preictal headache (Pre-IH: 4.3%). Less frequently, our patients noted interictal headache (Inter-IH: 31.9%). Interestingly, these subgroups exhibited different headache patterns with predominantly unclassified-type headache (U-TH) in patients with IH (72.7%), tension-type headache (T-TH) in patients with Post-IH (73.3%), and migraine-type headache (M-TH) in patients with Inter-IH (60%). ConclusionsOur results suggest that patients with epilepsy could exhibit different headache types. The clinical pattern of headache seemed to be linked to the time of seizure onset.

Features of the clinical picture in patients of middle age with essential hypertension.

To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatment-naïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.

Cyclic changes in sensations to painful stimuli in migraine patients.

Migraine is characterized by cycling phases (interictal, preictal, ictal and postictal) with differing symptoms, while in chronic tension type headache pain phases are fluctuating. The question we asked is whether these phases are associated with changes in parameters of somatosensation and axon-reflex erythema. Patients with episodic migraine and chronic tension type headache were examined psychophysically in the interictal, preictal and ictal phase and healthy subjects on five different test days. Thresholds and suprathreshold ratings of pressure and electrical pain were assessed on three different regions of the head. In migraine patients and in healthy controls, electrically induced axon-reflex erythema was measured in the area of the first trigeminal branch. All migraine patients filled out questionnaires about prodromal symptoms at every visit. The axon-reflex erythema was always larger in patients with migraine in contrast to healthy subjects. The pressure pain threshold was lower in migraine patients and chronic tension type headache in comparison to healthy subjects. Electrical pain thresholds did not differ between headache patients and healthy subjects and showed no changes between the phases. However, suprathreshold pain ratings showed less habituation solely in the preictal phase of migraine. The number of prodromal symptoms in migraine patients was increased in the preictal and ictal phase. Reduced habituation was the unique sign of the preictal phase in migraine patients, independently of prodromal symptoms, whereas a larger axon-reflex erythema and higher pressure pain sensitivity are constitutional and non-phase dependent properties of migraine. Reduced inhibitory mechanisms in the preictal phase may contribute to trigger headache attacks in migraine.

Yield of brain imaging among neurologically normal children with headache on wakening or headache waking the patient from sleep.

Headache on wakening (HoW) or sleep interruption secondary to headache (SIH) has been commonly regarded as a potential sign of raised intracranial pressure and therefore a sign of significant underlying pathology that necessitates further investigation. Current recommendations for neuroimaging in patients with HoW/SIH are neither consistent nor clear across headache guidelines published both nationally and internationally. The main aim of this study was to ascertain the relevance of HoW and/or SIH as an indication for routine neuroimaging. This study focused on clinically well patients with normal neurological examinations who had experienced HoW or SIH. Demographic and neuroradiological data were collected prospectively and the headache diagnosis was based on the International Classification of Headache Disorders. 102/1065 patients reported either HoW and/or SIH. There were 57/102 (56%) females, 45/102 males (44%), and 33/102 (32%) of ethnic minority. Their age ranged between 5 and 17 years. 79/102 (77%) patients with HoW, 19/102 (19%) with SIH and 4/102 (4%) with both HoW and SIH. Headache diagnosis included migraine (n=67; 66%), tension type headaches (n=16; 16%), medication overuse headaches (n=11; 11%), and sinusitis (n=1; 1%). Neuroimaging was performed in 101/102 patients; imaging was normal for 97 scanned patients, and showed non-significant abnormality in the remaining 4 patients. HoW or SIH among clinically well and neurologically normal paediatric patients was most likely to be caused by primary headaches, particularly migraine or tension type headaches. This symptom alone among healthy and clinically well children is not an indication for routine neuroimaging and is unlikely to be caused by sinister aetiologies.

Ictal epileptic headache: Is it a rare phenomenon?

Objectives Ictal epileptic headache (IEH) is a rare condition. Missing electroencephalographic (EEG) data, isolated ictal headaches can be linked to tension or migraine's headaches even among epileptic patient with substantial therapeutic implications [1] , [3] . Results Here we report the case of two female aged 12 and 40 year-old. Both were followed for epilepsy with Gastaut type benign occipital lobe epilepsy in the first case and focal symptomatic epilepsy due to right mesial temporal sclerosis in the second case. Medical history of migraine was found in the eldest case. At psychiatric evaluation, our youngest patient exhibited histrionic personality. Our two patients were adherent to their anti-epileptic drugs. However, they became complaining from recurrent episode with sudden brief headache, tightening in quality. EEG recording of our first case showed right posterior discharge of sharp theta rhythms concomitant with headache. In our second case, one typical seizures was evidenced during scalp EEG recording with only headache synchronous to discharges starting in the right temporal derivation and spreading to the contralateral side. Anti-epileptic drug was then adjusted in both cases. Conclusion The association between epilepsy and migraine, reported in our second case, make the situation more conflicting when suggesting subtle seizure manifesting as IEH [1] , [3] . Further, psychiatric comorbidity frequent in epileptic patients, as was our first case, made it often difficult to identify epileptic nature of headache [2] . Thus, in patients with epilepsy, the occurrence of isolated headache should be taken into account before stating that a patient is seizure-free. In patent without history of epilepsy, IEH is long time assimilated to migraine or tension type headache as EEG is not recommended as a routine examination in patients with isolated headache.