Image_1_Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International .pdf (124.2 kB)

Image_1_Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria.pdf

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posted on 2023-01-10, 06:15 authored by Arife Çimen Atalar, Aynur Özge, Bengi Gül Türk, Esme Ekizoğlu, Duygu Kurt Gök, Betül Baykan, Semih Ayta, Füsun Ferda Erdoğan, Seher Naz Yeni, Bahar Taşdelen, IDEM Study Group, Sibel K. Velioğlu, Zuhal Yapıcı, İpek Midi, Saygı Serap, Çelebi Ulufer, Elif Sarıca Darol, Kadriye Ağan, Senem Ayç, Sibel Gazioğlu, Zeynep Vildan Okudan, Nermin Görkem Şirin, Nerses Bebek, Neşe Dericioğlu, İlknur Güçlü Altun, Ayşe Destina Yalçın, Reyhan Sürmeli, Oğuz Osman Erdinç, Abidin Erdal, Demet İlhan Algın, Gülnihal Kutlu, Semai Bek, Yüksel Erdal, Akçay Övünç Özön, Aylin Reyhani, Babürhan Güldiken, Barış Baklan, Bülent Oğuz Genç, Ebru Aykutlu Altindağ, Gökçen Karahan, Güray Koç, Handan Mısırlı, İbrahim Öztura, Kezban Aslan-Kara, Melodi Çakar Merve, Nur Türkmen, Onur Bulut, Karadaş Ömer, Özlem Kesim Çahin, Sevgi Ferik, Taylan Peköz Mehmet, Pınar Topaloğlu, Sibel Üstün Özek, Ülkühan Düzgün, Vildan Yayla, Yasemin Gömceli, Zeynep Ünlüsoy Acar

Background

Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.

Methods

In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.

Results

Longer headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.

Conclusion

Longer headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.