Peri-ictal headache: An underestimated prognostic finding associated with idiopathic epilepsies.

OBJECTIVE: There are a handful of studies investigating peri-ictal headache (PIH) and its clinical associations in patients with idiopathic/genetic epilepsies (I/GE). This multi-center study aimed to investigate PIH, which is an ignored comorbid condition in patients with I/GE, by headache experts and epileptologists working together. METHODS: The data were collected from a cross-sectional large study, using two structured questionnaires for headache and epilepsy features, fulfilled by neurologists. Headaches were classified according to the International Classification of Headache Disorders, third edition, whereas seizure and syndrome types were diagnosed according to International League Against Epilepsy criteria. The patients with a headache starting 24 hours before the onset of the seizure (preictal) or within 3 hours after the seizure (postictal) were defined as patients with PIH. We compared demographic and clinical differences between two groups of patients with and without PIH statistically and used ROC curves to determine a threshold of the total number of seizure triggers associated with the occurrence of PIH. RESULTS: Among 809 (531 females, 65.6%) consecutive patients with I/GE, 105 (13%) patients reported PIH (22 preictal, 82 postictal headaches, and one with both types). Peri-ictal headache was more frequently reported by females and those having a family history of migraine or epilepsy, and it was significantly associated with lower rates of seizure freedom for more than five years, drug resistance, and use of polytherapy, remarkably. Moreover, ROC curves showed that having more than 3 seizure triggers was associated with the presence of PIH. CONCLUSION: Our findings revealed that PIH may be linked to poor outcomes in I/GEs and seems to be related to a lower ictal threshold precipitated by multiple triggers. Future prospective studies will illuminate the unknown underlying mechanisms and appropriate management strategies for PIH to improve the prognosis.

[Investigation of the risk factors for the transition of episodic migraines to chronic migraines]. / Kronik migrene dönüsüm üzerine etkili risk faktörlerinin arastirilmasi.

OBJECTIVES: Chronic migraine (CM) is a frequent complication of migraines that has a serious impact on personal and social life and is still underdiagnosed. The aim of this study was to determine risk factors for the progression to CM and to investigate the relationship of these factors to the disease prognosis. METHODS: In all, 115 CM and 377 episodic migraine patients from between February 2015 and December 2017 were enrolled. The age of disease onset, headache duration and frequency, presence of aura and type of aura, clinical properties and location of headache, pain severity, trigger factors, presence of family history, visual analogue scale (VAS) and Allodynia Symptom Checklist (ASC) scores, presence of allodynia, and Migraine Disability Assessment (MIDAS) scores were recorded and the 2 groups were compared statistically. Logistic regression was used to determine the independent risk factors for a conversion to CM. RESULTS: The mean age of the 492 patients (408 female, 84 male) was 36.03±12.67 years, the disease duration was 10.78±10.36 years, the attack frequency was 10.35±9.06 attacks/month, and the attack duration was 30.10±23.54 hours. There were 115 patients (104 female, 11 male) with CM. Female gender (p=0.015), attack frequency (p<0.001), ASC score (p=0.002), VAS score (p=0.001), and MIDAS score (p<0.001) had greater representation in the CM group. Medication overuse (relative risk [RR]: 0.9) and allodynia (RR: 0.3) were independent risk factors for a transition to CM in the logistic regression analysis (p<0.05). CONCLUSION: Based on the present data of a tertiary headache center, it was concluded that CM is a disabling neurological disease with a serious personal and public burden. Special care should be taken among patients with medication overuse and cutaneous allodynia with regard to the possibility of transition to CM.

[What is the impact of having a family history of migraine on migraine characteristics?] / Ailede migren öyküsü bulunmasinin migren özelliklerine etkisi nedir?

OBJECTIVES: There are only a handful of studies examining the clinical differences between patients with and without a family history of migraine. Our aim is to compare the descriptive and clinical properties of patients with and without a family history, and to investigate the association between the migraine burden and disease characteristics and disability of migraine. METHODS: A total of 530 consecutive patients diagnosed with migraine according to the International Headache Society criteria were enrolled into the study. Detailed systemic and neurological examinations, and blood pressure, weight, height, and body mass index measurements, clinical and demographical data, the visual analog scale, allodynia symptom checklist, and the Migraine Disability Assessment Scale (MIDAS) scores were recorded. The groups with and without a family history of migraine were compared statistically. RESULTS: Patients with a positive family history had a higher educational status (high school and higher) (p<0.05) and an increased triggering of pain with physical activity (p=0.013). The age at onset was earlier (p=0.049); disease duration was longer (p=0.030), and MIDAS scores were significantly higher (p=0.028) in patients with a family history of migraine. CONCLUSION: Having a family history of migraine is associated with an earlier age at onset and a longer disease duration, in addition to an increased disability in these patients. The family history may be assumed as a marker of the genetic load in migraineurs; therefore, an early diagnosis and an appropriate management are essential in these patients to avoid migraine-related disability.

Alien hand syndrome and migraine with aura: A case report.

BACKGROUND: Alien Hand Syndrome (AHS) is an uncontrollable, involuntary, but in appearance, purposeful motor control disorder of the upper extremity. CASE REPORT: A 42-year-old male patient was admitted to our clinic complaining of involuntary motor activity in his right hand. He had a previous history of migraine with visual aura. The uncontrollable motor control disorder was compatible with Alien Hand Syndrome, which was appearing immediately after the visual aura and before the beginning of headache. CONCLUSION: Alien Hand Syndrome is usually observed with anterior cerebral artery infarction, midline tumors, trauma and several neurodegenerative diseases, but is rarely seen in paroxysmal conditions such as migraine with aura.