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 [1Parisi P., Verrotti A., Costa P., Striano P., Zanus C., Carrozzi M., e al. Diagnostic criteria currently proposed for “ictal epileptic headache”: perspectives on strengths, weaknesses and pitfalls Seizure 2015 ;  31 : 56-63 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Wang X., Lang S., Zhang X., Zhu F., Wan M., Shi X., e al. Comorbidity between headache and epilepsy in a Chinese epileptic center Epilepsy Res 2014 ;  108 : 535-541 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti].

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.

The association between epilepsy and migraine, reported in our second case, make the situation more conflicting when suggesting subtle seizure manifesting as IEH [1Parisi P., Verrotti A., Costa P., Striano P., Zanus C., Carrozzi M., e al. Diagnostic criteria currently proposed for “ictal epileptic headache”: perspectives on strengths, weaknesses and pitfalls Seizure 2015 ;  31 : 56-63 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Wang X., Lang S., Zhang X., Zhu F., Wan M., Shi X., e al. Comorbidity between headache and epilepsy in a Chinese epileptic center Epilepsy Res 2014 ;  108 : 535-541 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. Further, psychiatric comorbidity frequent in epileptic patients, as was our first case, made it often difficult to identify epileptic nature of headache [2Verrotti A., Carrozzino D., Milioni M., Minna M., Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children J Neurol Sci 2014 ;  343 : 23-29 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti]. 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.