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Postictal Headache In South African Adult Patients With Generalised Epilepsy In A Tertiary Care Setting: A Cross-sectional Study

Stephanus Schmidt Botha, Clara-Maria Schutte, Steve Olorunju, Mandisa Kakaza

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Postictal headache (PIH), although it occurs in 34–59% of epilepsy patients, has not been adequately studied. This study aims to describe clinical characteristics and associations of PIH in generalised epilepsy in a South African tertiary neurology clinic. Methods: Two-hundred consecutive adults with generalised epilepsy underwent semi-structured interviews, dividing them into study (with PIH) and control patients (no PIH), and data was statistically analysed. Results: PIH occurred in 104/200, with 63% having headache after every seizure. Pain duration was 4–24 hours in 43% and pain intensity severe in 55%. The criteria of the International Headache Society (2004), International Classification of Headache Disorders, second edition (ICHD-II) classified 47% as migraine, 38% tension-type and 15% unclassified (but 13% probable migaine). Self-medication occurred in 81% and interictal headache was significantly associated with PIH—present in 64% of study patients versus 5% of control patients. Conclusion: PIH occurs commonly in generalised epilepsy, mostly as migraine headache, with interictal headache a specific risk factor. PIH is underdiagnosed and undertreated, leading to self-medication. Optimal management should be elucidated in future studies.