Frontal headache in a patient with right temporal epilepsy: A video-EEG case report of ictal epileptic headache

BackgroundIctal epileptic headache (IEH) is caused by a focal epileptic seizure. The diagnosis can be challenging when the headache is isolated without any other symptoms. Case ReportA 16-year-old girl presented with a 5-year history of bilateral frontotemporal headaches with severe intensity lasting for 1-3 min. Past medical, physical, and developmental histories were unremarkable. Head magnetic resonance imaging showed right hippocampal sclerosis. The diagnosis of pure IEH was confirmed by video-electroencephalographic monitoring. The onset and cessation of frontal headache correlated with a right temporal discharge. The patient was diagnosed with right mesial temporal lobe epilepsy. Two years later, her seizures increased despite antiseizure medications. A right anterior temporal lobectomy was performed. The patient remained seizure-free and headache-free for 10 years. ConclusionIEH should be considered in the differential diagnosis of brief and isolated headache, even if the headache is diffuse or contralateral to the epileptogenic focus.

Automated summary

This case report describes a 16-year-old girl with a 5-year history of severe bilateral frontotemporal headaches. Right hippocampal sclerosis was found on head magnetic resonance imaging. The diagnosis of pure ictal epileptic headache was confirmed by video-electroencephalographic monitoring. The patient underwent a right anterior temporal lobectomy and remained seizure-free and headache-free for 10 years.