Epilepsy and headache have both episodic speed and share overlapping mechanisms and symptoms such as sensory and vegetative aura [1Belcastro V., Striano P., Parisi P. Ictal epileptic headache: beyond the epidemiological evidence Epilepsy Behav 2012 ;  25 : 9-10 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. Diagnosis as well as management is sometimes challenging since different types of electroencephalographic (EEG) abnormalities have been reported during migraine and tension type headache within headache free periods [2Chastan N., Lebas A., Legoff F., Parain D., Guyant-Marechal L. Clinical and electroencephalographic abnormalities during the full duration of a sporadic hemiplegic migraine attack Neurophysiol Clin 2016 ;  46 : 307-311 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Ozkan M., Teber S.T., Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches Pediatr Neurol 2012 ;  46 : 154-157 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti]. These abnormalities include spikes, sharp waves, slow waves, and increase in theta activity [3Ozkan M., Teber S.T., Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches Pediatr Neurol 2012 ;  46 : 154-157 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti].

Here we report a 60-year-old woman who presented to our department for episodic headache attacks. Her family history was positive for migraine and febrile seizure. She described sudden severe bifrontal headache, tightening in quality, associated with dizziness and lasting at least 12hours. Our patient was diagnosed with tension type headache according to the International Classification of Headache Disorders (ICHD). She unfortunately still suffering from her pain despite optimal analgesic medications. We, therefore, performed EEG monitoring, which demonstrated periodic right spike and wave discharges diffusing to contralateral side within headache free periods. Magnetic resonance imaging (MRI) showed nonspecific deep white matter T2 and Flair hyperintense lesions.

To the best of our knowledge, tension type headache is rarely associated with EEG abnormalities [2Chastan N., Lebas A., Legoff F., Parain D., Guyant-Marechal L. Clinical and electroencephalographic abnormalities during the full duration of a sporadic hemiplegic migraine attack Neurophysiol Clin 2016 ;  46 : 307-311 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Ozkan M., Teber S.T., Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches Pediatr Neurol 2012 ;  46 : 154-157 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti]. In fact, previous report for EEG abnormalities’ rate in tension-type headaches was about 5.9% according to Piccinelli and al and 2% according to M. Ozkan et al. [3Ozkan M., Teber S.T., Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches Pediatr Neurol 2012 ;  46 : 154-157 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti]. These finding in addition to ours suggest transient that headache could result from transient cortical excitability [3Ozkan M., Teber S.T., Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches Pediatr Neurol 2012 ;  46 : 154-157 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti].