Clinical Profile of Headache in Epilepsy: Experience from a Tertiary Center in South India

Background: Headache and epilepsy are two of the most common neurological disorders, with a complex bidirectional relationship. Up to half of individuals with epilepsy experience headaches, most frequently migraines and tension-type headaches. This study aimed to analyze the prevalence, clinical features, and seizure-related temporal patterns of headaches in epilepsy patients from a tertiary center in South India. Materials and Methods: A cross-sectional observational study was conducted from April 2023 to March 2024, involving 82 patients with epilepsy and headache who were recruited from the outpatient clinic of the Neurology department at a tertiary hospital in South India. Clinical data on headache characteristics, temporal association with seizures, comorbid features, seizure profile, and electroencephalography (EEG) were recorded. Results: Of the 82 patients, 36 were male and 46 were female. Migraine without aura (56.1%) was the most common type of headache, followed by tension-type headache (18.3%). Interictal headache was reported in all patients, whereas postictal headache occurred in 54.9%, preictal headache in 11.0%, and ictal headache in 1.2%. Headaches were mostly moderate in severity (53.7%), with severe headaches restricted to patients with generalized tonic clonic seizures (GTCS). Focal seizures were significantly associated with preictal headaches (23.8%). GTCS was the predominant seizure type (86.6%). Patients with abnormal EEGs and mesial temporal sclerosis had more frequent, severe headaches and required polytherapy. Conclusions: Headache, particularly interictal and postictal, is highly prevalent in epilepsy and is closely linked to seizure characteristics and age of onset. Proactive screening and judicious selection of antiepileptic drugs with dual efficacy can optimise both seizure control and headache management.