Don’t Miss Migraines in Patients with Drug-Resistant Epilepsy

Headaches can occur following epilepsy surgery, and differentiating primary (e.g., migraine) from secondary (e.g., intracranial hypertension) headaches can be a challenge.

A female patient developed drug-resistant epilepsy with epilepsia partialis continua at the age of 10 years with progressive cognitive decline, prompting the diagnosis of Rasmussen's encephalitis. At 12 years of age, a right-side hemispherotomy was performed and brought forth seizure freedom.

Post hemispherotomy, the girl presented repeatedly to our clinic for severe headaches, lasting up to 15 days. She reported 10 to 15 headache days per month. Secondary headache causes including intracranial hypertension were excluded. Remission was achieved through intravenous metamizole and oral ibuprofen, but headaches returned rapidly as soon as treatment was terminated. Retrospectively, the girl had experienced recurrent headaches already prior to hemispherotomy; however, her ability to communicate pain had been severely impaired at that time due to her primary disease. Her headaches met all required criteria for a migraine without aura. She was therefore given 7.5 mg/kg magnesium citrate daily as preventive treatment and instructed to use sumatriptan or metamizole as acute medication. These measures substantially improved headache frequency and attack duration.

With this case report, we would like to point toward the possibility of a primary headache in patients with drug-resistant epilepsy and post epilepsy surgery as a differential diagnosis to secondary headaches such as intracranial hypertension. Introspection and ability to articulate headaches can be impaired in patients with drug-resistant epilepsy and hinder proper diagnosis and therapy. A substantial decrease of headache attack frequency can be achieved through simple measures.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 October 2021