Who’s still afraid of the link between headache and epilepsy? Some reactions to and reflections on the article by Marte Helene Bjørk and co-workers

Excerpt

I was delighted to be invited to comment on the article by Marte Helene Bjørk and co-workers entitled “Interictal quantitative EEG in migraine: a blinded controlled study”, published in this issue of The Journal of Headache and Pain [1]. I was delighted for three reasons. Firstly, because this article makes a major effort to shed light on the inter-ictal cortical excitability changes using a quantitative EEG (QEEG) investigation in migraine-affected subjects. Secondly, because this commentary offers me the opportunity to stress the need to, respectively, define and revise criteria in both the International League Against Epilepsy (ILAE) classification and International Classification of Headache Disorders Second-Revision (ICHD-II). Indeed, to date neither the International Headache Society nor the International League against Epilepsy mention that headache/migraine may, on occasion, be the sole ictal epileptic manifestation. This is reflected in the ICHD-II criteria, both for the “hemicrania epileptica” classification (coded as 7.6.1) where you can see….in point B of criteria…. … “the patient is having a partial epileptic seizure”… and for “post-ictal headache” classification (coded as 7.6.2) where you can see in point B of criteria…. “the patient has had a partial or generalized epileptic seizure”. Thirdly, The Journal of Headache and Pain’s readers represent the most suitable audience with whom to share some recent contributions to this hot topic by our group [2‐6]. I will thus focus on the main findings of this well-conducted study by Marte Helene Bjørk et al., and will conclude with some reactions to and reflections on our recent papers [2‐6], which are, I feel, more closely related to the article commented on here than might appear at first glance. …