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Abstract. Headache is often ignored as a symptom of epileptic seizure. To date, there have been no reports of ice pick headache as a symptom or association in epileptic seizure. Six children (ages 5.5-10 years; average 8.6 years; male-female ratio, 2:1) presenting with ice pick headache and paroxysmal electroencephalographic changes compatible with the diagnosis of epilepsy were evaluated. Only 66.6% had clinical seizures. The antiepileptic drugs were consistently effective in all cases. These findings seem to suggest that a distinct group of symptoms and signs (ice-pick headache, paroxysmal electroencephalographic changes, and epileptic seizure), which, associated together form a characteristic clinical picture or entity. This is the first report, to date. This report highlights the necessity to further search this unique clinical condition.
Key words: Ice pick headache, paroxysmal electroencephalographic changes, and epileptic seizure
1. Introduction
Headaches may occur in rare circumstances during a seizure. Symptoms besides headache may be either present or absent. The headaches itself may limit children's ability to observe or recall the manifestations of seizures. In Blume and Young's epilepsy unit, 2.8% of 858 patients had brief ictal pain and 1.3% (11 patients) had headache (1). Lansche (2) first described idiopathic stabbing headache as ophtalmodynia periodica in 1964. Since then, this disease has been designated by various terms, including icepick like pains, sharp short-lived headache , jolt and jabs headache, and idiopathic stabbing headache (2-5). Idiopathic stabbing headache is characterized by brief, sharp, severe jabbing pains about the head that occur either as single episodes or as brief repeated volleys. The pain resembles a stab from an ice pick, nail, or needle and typically lasts from a fraction of a second to 1 to 2 seconds (3). The frequency of attacks varies immensely, ranging from 1 attack per year to 50 attacks per day. Short-lasting headaches have been studied infrequently in children (6-8). To date, there have been no reports of association of ice-pick headache and epileptic seizure .
2. Materials and methods
This study was set up at the author's private out -patient neurology clinic in remote North-East India in February 2002. Children with ice-pick headaches that occurred in isolation or in a cluster, with or without clinical seizures, without other primary headache syndromes at the time of presentation,...