Ictal Headache: A Case Report

TL;DR

A 23-year-old woman's severe headaches were found to be caused by epilepsy, highlighting a rare condition called ictal headache.

Contribution

This case report highlights the rare occurrence of headache as the sole manifestation of epilepsy, aiding in the recognition of ictal headache.

Findings

Severe headache was the only symptom of epilepsy in a 23-year-old female.

Oxcarbazepine treatment confirmed the diagnosis of ictal headache.

Ictal headache is a rare manifestation of focal seizures and is often difficult to diagnose.

Abstract

Migraine and epilepsy are traditionally considered to be unrelated conditions; however, they share pathophysiological mechanisms that could lead to headache associated with seizures or headache as the sole manifestation of epilepsy. We present a case of a 23-year-old female patient with severe headache as the only manifestation of epilepsy, and after multiple treatments without improvement, she underwent an electroencephalogram that showed epileptic activity coincident with the headache. The patient responded positively to oxcarbazepine, confirming the diagnosis of ictal headache. Ictal headache is an infrequent manifestation of epilepsy, primarily in focal seizures, and the diagnosis is often challenging due to the similarity of symptoms with other types of headaches and the difficulty in detecting epileptic discharges during the headache.

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