Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort
Authors: Atalar Arife Çimen , Türk Bengi Gül , Ekizoglu Esme , Kurt Gök Duygu , Baykan Betül , Özge Aynur , Ayta Semih , Erdoğan Füsun Ferda , Yeni Seher Naz , Taşdelen Bahar , Velioglu Sibel K. , Yapıcı Zuhal , Midi İpek , Saygı Serap , Çelebi Ulufer , Sarıca Darol Elif , Ağan Kadriye , Ayça Senem , Gazioğlu Sibel , Okudan Zeynep Vildan , Şirin Nermin Görkem , Bebek Nerses , Dericioğlu Neşe , Güçlü Altun İlknur , Yalçın Ayşe Destina , Sürmeli Reyhan , Erdinç Oğuz Osman , Erdal Abidin , İlhan Algın Demet , Kutlu Gülnihal , Bek Semai , Erdal Yüksel , Özön Akçay Övünç , Reyhani Aylin , Güldiken Babürhan , Baklan Barış , Genç Bülent Oğuz , Aykutlu Altındağ Ebru , Karahan Gökçen , Koç Güray , Mısırlı Handan , Öztura İbrahim , Aslan‐Kara Kezban , Çakar Merve Melodi , Türkmen Nur , Bulut Onur , Karadaş Ömer , Kesim Şahin Özlem , Ferik Sevgi , Peköz Mehmet Taylan , Topaloğlu Pınar , Üstün Özek Sibel , Düzgün Ülkühan , Yayla Vildan , Gömceli Yasemin , Ünlüsoy Acar Zeynep 
Published: February 2022

Objective

The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features.

Methods

Patients aged 6–40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K‐means algorithm.

Results

Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic–clonic seizures (GTCS) were clustered in this group (Cluster 1). Self‐limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99).

Significance

Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.