Clinical Profile of Primary Headache Disorders in Patients with Epilepsy and Response to Standard-of-Care Migraine Preventive Treatment: A South Asian Cohort
Abstract
Abstract Background Headache is among the most frequent comorbidities of epilepsy, yet its clinical profile is poorly characterised and prospective data on treatment response are scarce, particularly from South Asia. This study aimed to characterise the prevalence, profile and predictors of primary headache disorders (PHD) in patients with epilepsy (PWE), and the response of comorbid migraine to 3 months of preventive treatment. Methods Over 18 months at a tertiary-care centre in northern India, PWE were prospectively screened for a co-existing PHD. Headaches were classified by ICHD-3 and their temporal relationship to seizures. Predictors of headaches were identified by multivariable logistic regression. Patients with comorbid migraine received standard preventive treatment, reviewed monthly for 3 months; monthly headache-day, migraine-day and seizure counts were compared across visits with the Friedman test (post-hoc Wilcoxon signed-rank), and ≥ 50%-responder proportions with Cochran’s Q, with intention-to-treat sensitivity analysis. Results Of 814 PWE screened, 346 (42.5%; 95% CI 39.2–45.9) had a PHD. Interictal headache predominated (314; 90.8%), most often migraine (218; 69.4%). Female sex (adjusted OR 2.41; 95% CI 1.46–3.99) and poorer seizure control (adjusted OR 1.63 per category; 1.05–2.51) were independently associated with migraine; antiseizure medication count was not. With migraine preventive treatment, median migraine days progressively fell from 4 to 1 and…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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