Clinical characteristics of epilepsy patients with comorbid headache: experience from a tertiary epilepsy center

Clinical characteristics of epilepsy patients with comorbid headache: experience from a tertiary epilepsy center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical characteristics of epilepsy patients with comorbid headache: experience from a tertiary epilepsy center Shujiang Zhang, Zhiyu Lv, Jinmei Li, Dong Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5752176/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 May, 2025 Read the published version in BMC Neurology → Version 1 posted 12 You are reading this latest preprint version Abstract Background Headache is one of the most common comorbidities in epilepsy, with affected patients experiencing various types of headaches. This study aimed to investigate differences in comorbid headache types across epilepsy origins, comparing pain levels among epilepsy patients with multiple headache types, and exploring associations between headache characteristics and epilepsy prognosis. Methods We retrospectively analyzed consecutive adult epilepsy patients with comorbid headache, collecting comprehensive sociodemographic, epilepsy-related, and headache-related data, as well as data on headache-attributed lost time and quality of life. The overall prevalence of headache comorbidity in epilepsy was determined, and we compared clinical characteristics, quality of life, and headache-attributed lost time across different epilepsy origins. Based on the temporal relationship between headache and seizures, comorbid headaches were classified into inter-ictal headache (Inter-IH), ictal headache, pre-ictal headache (Pre-IH), and post-ictal headache (Post-IH) for subgroup analysis to explore differences in clinical characteristics by headache type. We conducted multiple logistic regression and receiver operating characteristic (ROC) analyses to calculate the area under the curve (AUC), assessing correlations between headache characteristics and epilepsy prognosis and the predictive accuracy for drug-refractory epilepsy (DRE). Results A total of 539 epilepsy patients with comorbid headache were included, comprising 233 with Inter-IH (43.22%), 38 with Pre-IH (7.05%), and 423 with Post-IH (78.48%); no patients had ictal headache. Among those with Inter-IH, 58 (10.76%) met the diagnostic criteria for migraine, and 87 (16.14%) met the criteria for tension-type headache. In our cohort, 7 patients (1.30%) experienced both Inter-IH and Pre-IH, 112 (22.08%) had both Inter-IH and Post-IH, 7 (1.30%) experienced Inter-IH, Pre-IH, and Post-IH, and 18 (3.34%) had both Pre-IH and Post-IH. The study included 382 patients with focal epilepsy (70.87%), 40 with generalized epilepsy (7.42%), and 117 with epilepsy of unknown origin (21.71%), with temporal lobe epilepsy being the most common focal type, representing 46.07% of cases. Patients with focal epilepsy reported lower quality of life than those with epilepsy of unknown origin (QOLIE-10, p < 0.05) and had a lower proportion of bilateral Post-IH than those with epilepsy of unknown origin ( p < 0.05). The proportion of patients with level 1 Headache-Attributed Lost Time-90 Days (HALT-90) was higher in generalized epilepsy than in focal (87.50% vs. 66.23%, p < 0.05) and unknown origin (87.50% vs. 64.96%, p < 0.05). Comorbid migraine and HALT-90 were associated with DRE ( p < 0.05), although predictive accuracy was low (AUC = 0.539; AUC = 0.566, respectively). Conclusion The most common type of epilepsy with comorbid headache was focal origin, with patients experiencing poorer quality of life than those with epilepsy of unknown origin. Clinical characteristics of comorbid headaches did not vary significantly by epilepsy origin, but patients with generalized epilepsy and comorbid headache had the least time lost. Post-IH was the most common type of comorbid headache. While comorbid migraine and HALT-90 were associated with DRE, the predictive accuracy for DRE was insufficient. Comorbid headache inter-ictal headache pre-ictal headache post-ictal headache epilepsy origin Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Introduction Epilepsy is a common neurological disorder marked by recurrent seizures, which significantly impact the physical and mental well-being of patients and are a focus of global neurological research. Comorbid conditions associated with epilepsy have become an important area of study, and in 2017, the International League Against Epilepsy (ILAE) emphasized the need to identify and manage these comorbidities in its updated classification criteria [ 1 ]. Headache is one of the most frequently reported comorbidities in epilepsy, though studies show variation in the epidemiology of comorbid headaches across different countries [ 1 , 2 ]. The mechanisms linking headache and epilepsy, however, remain largely unknown. Comorbid headaches in epilepsy can significantly reduce quality of life, and headache symptoms often exacerbate negative emotions in epilepsy patients, further affecting their overall well-being [ 2 ]. Despite these impacts, comorbid headaches in epilepsy patients often go undiagnosed and untreated, underscoring the importance of studying the clinical characteristics of these headaches and exploring their potential relationship with epilepsy prognosis [ 2 , 3 ]. Headache comorbidities in epilepsy are categorized based on their timing in relation to seizures into peri-ictal headaches, which occur around the time of a seizure (including pre-ictal [Pre-IH], ictal, and post-ictal [Post-IH) headaches), and inter-ictal headaches, which occur independently of seizure activity [ 4 , 5 ] (Table 1 ). Some patients experience multiple types of headaches, and the characteristics of these headaches may vary depending on the epilepsy origin. In this study, we aimed to investigate differences in headache comorbidities across various types of epilepsy origins and compare pain levels among epilepsy patients with multiple comorbid headache types. Additionally, we explored the potential association between headache characteristics and epilepsy prognosis. Materials and methods This study enrolled inpatients and outpatients with epilepsy and comorbid headache from the Epilepsy Center at the West China Hospital of Sichuan University between June 2021 and June 2022. The study received approval from the Institutional Review Board of the West China Hospital of Sichuan University (approval number 2022301). Written informed consent, in line with the Declaration of Helsinki, was obtained from all participants after providing them with detailed information about the study. Study objectives Diagnostic criteria for epilepsy: Diagnosis was based on the 2014 ILAE Clinical Practical Definition of Epilepsy [ 6 ]. A diagnosis of epilepsy was made if any of the following conditions were met: (1) at least two unprovoked (or reflex) seizures occurring more than 24 hours apart; (2) one unprovoked (or reflex) seizure with a risk of recurrence within 10 years comparable to that after two unprovoked seizures (60%); or (3) diagnosis of an epilepsy syndrome. Inclusion criteria: Participants were eligible if they were (1) over 18 years of age; (2) had epilepsy for more than 6 months; (3) had complete clinical data, including a 24-hour electroencephalogram and brain magnetic resonance imaging (MRI); (4) experienced headache symptoms during their epilepsy (Inter-IH, Pre-IH, ictal headache, or Post-IH); and (5) agreed to participate in the study, undergo a structured interview, and complete a questionnaire. Exclusion criteria: Participants were excluded if they (1) had cognitive impairments or mental illnesses that prevented them from completing the questionnaire; (2) had incomplete clinical data; (3) submitted incomplete questionnaires; or (4) declined to participate. Methods Patients were enrolled consecutively, informed of the study's purpose, content, and procedures, and assured of voluntary participation and privacy protection. Informed consent was obtained from all participants. Data collected included demographics, epilepsy history, and headache characteristics. Pain severity was measured using the visual analog scale (VAS). The Headache-Attributed Lost Time-90 Days (HALT-90) questionnaire assessed headache-related time loss, while the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) evaluated quality of life. The accuracy of completed questionnaires was verified on the day of the interview, and questionnaires with missing or incorrect information were excluded. Two neurology specialists reviewed the data, reaching consensus through consultation when necessary. Demographic data and lifestyle questionnaire The questionnaire gathered the following information: (1) basic details such as name, age, sex, and education level (illiterate/primary school/junior high school/senior high school/college/bachelor's degree/master's degree/doctor's degree/postdoctoral); (2) epilepsy information, including age at onset, disease course, family history, history of birth asphyxia or febrile seizures, brain trauma, encephalitis, or surgery, seizure type and frequency, status epilepticus history, electroencephalogram (EEG), brain MRI findings, antiseizure medication (ASM) use, and QOLIE-10; and (3) headache-related information, such as family history of headache, headache type (Inter-IH, Pre-IH, ictal headache, or Post-IH), headache characteristics, location (unilateral or bilateral), inter-ictal headache with or without aura, duration and frequency, response to sleep, analgesic use, VAS, and HALT-90. The QOLIE-10 [ 7 ] includes the following 10 items: (1) are you energetic? (responses: all of the time, most of the time, some of the time, rarely, and never; scored from 1 to 5 points, respectively); (2) do you feel depressed (scored the same as item 1); (3) is epilepsy or ASM causing your driving impairment? (scored the same as item 1); for items 4–8, respondents are asked how often they have been troubled by the following situations in the past 4 weeks: (4) memory impairment (responses: not bothered at all, rarely bothered, some of the time, a lot of the time, extremely bothered; scored from 1 to 5 points, respectively); (5) work limitation (scored the same as item 4); (6) social function limitation (scored the same as item 4); (7) physical effects of ASM (adverse reactions) (scored the same as item 4); (8) effects of ASM (scored the same as item 4); (9) how afraid are you of having a seizure next month? (responses: not at all, average, moderate, very afraid, extremely afraid; scored from 1 to 5 points, respectively); (10) What was your quality of life during the past 4 weeks? (responses: excellent, very good, mixed, fairly bad, very bad; scored from 1 to 5 points, respectively). A higher total score indicates a worse quality of life for the patient. HALT-90 calculation rules [ 8 ]: (1) How many days in the past 3 months have you been unable to go to work or school because of a headache? (2) How many days in the past 3 months have you had a headache that partially affected your work or school (decreased productivity by more than half)? (3) How many days in the past 3 months have you been unable to do housework because of your headache? (4) How many days during the past 3 months did you have a headache that partially prevented you from doing housework? (5) In the past 3 months, how many days did you miss visiting family and friends, parties, entertainment such as watching movies and playing cards because of your headache? The assessment criteria are as follows: level 1 (rarely): 0–5 days; level 2 (mild or infrequent): 6–10 days; level 3 (moderate, indicating a need for care): 11–20 days; level 4 (severe, indicating a great need for care) ≥ 20 days. Assessment of epilepsy-related information Epilepsy-related data, including seizure classification, head MRI and EEG findings, ASM use, seizure frequency, and drug-refractory epilepsy (DRE) status, were assessed by two specialists based on the ILAE criteria. Epilepsy was classified by origin (focal, generalized, or unknown) [ 9 ]. Frequent seizures were defined as occurring ≥ 1 time per month. DRE was defined per the ILAE 2010 criteria [ 10 ] as a failure to remain seizure-free after at least two appropriately chosen and well-tolerated ASM regimens, used either alone or in combination. The patient's seizure-free time did not exceed three times or 1 year (whichever was longer) of the longest seizure interval compared with before treatment. Status epilepticus was defined according to the 2001 ILAE position paper [ 11 ], which is defined as a seizure that lasts longer than typical seizures in most patients with the same seizure type, showing no signs of stopping or recurring seizures, and during which the state of consciousness does not return to baseline. It generally refers to (1) any seizure lasting more than 5 minutes, (2) more than two seizures without full recovery of consciousness, (3) seizures during which consciousness does not return to baseline, (4) partial seizures lasting more than 10 minutes, or (5) absence of seizures lasting more than 15 minutes. Headache comorbidity related definitions The classification criteria [ 12 , 13 ] for epilepsy-related headache comorbidities were based on established guidelines. Inter-ictal headaches were classified according to the International Classification of Headache Disorders-3rd Edition (ICHD-III) [ 13 ] as migraines, tension-type headaches, or other types (Table 2 ). Peri-ictal headaches were further characterized by migraine-like or tension-type headache-like based on diagnostic criteria. Observation index Main outcome measures: To examine the composition of comorbid headaches in epilepsy patients and analyze clinical differences in headache types across different epilepsy origins. Secondary outcome measures: To explore the correlation between headache characteristics and DRE. Statistical analysis Data analysis was performed using SPSS 25.0 ( http://www.ibm.com/cn-zh/spss ) and image rendering using Datagraph 4.6 ( http://community.visualdatatools.com/datagraph/ ). Normally distributed data were expressed as mean ± SD, while non-normally distributed data were presented as median and interquartile range. Categorical data were presented as percentages. For statistical analysis, education levels were classified as “low” (high school and below) and “non-low” education level. To explore the differences in clinical characteristics of comorbid headache, we compared the demographic, sociological, headache-related, and epilepsy-related indicators in patients with epilepsy of different origins. A two-sided p -value of < 0.05 was considered statistically significant. One-way analysis of variance was used to compare normally distributed continuous variables among groups, with post-hoc correction via Bonferroni adjustment (significance level p < 0.05). For non-normally distributed continuous variables, the rank-sum test was applied. Categorical variables were compared using the chi-square test or Fisher’s exact test, with Bonferroni correction for multiple comparisons when p < 0.05. Logistic regression assessed the correlation between headache characteristics and epilepsy outcomes, and the predictive accuracy of headache characteristics for DRE was evaluated through receiver operating characteristic (ROC) curve analysis, calculating the area under the curve (AUC) for precision measurement. Results A total of 543 epilepsy patients with comorbid headache met the study's inclusion and exclusion criteria and completed the questionnaire. Of these, four questionnaires were excluded due to missing information, resulting in a final sample size of 539 patients. Details are presented in Table 3. Among the 539 patients, the average age was 30.29 years (range: 17-69 years), with women comprising 56.59% of the sample (305 individuals). Approximately 49.17% of participants had a high school education or below. The mean age of epilepsy onset was 18.94 years, and the average duration of epilepsy was 11.33 years. A family history of epilepsy was reported in 6.49% of patients. Generalized tonic-clonic seizures (GTCS) occurred in 84.23% of patients, while 9.46% experienced status epilepticus. Abnormalities associated with epilepsy were detected in 76.44% of patients who underwent EEG examination, while 57.14% had abnormalities on head MRI. Additionally, 32.28% of the sample met the criteria for DRE. Regarding ASM use, 33.21% of patients were on monotherapy, 55.29% were on polytherapy, and 11.50% were not taking any ASM. The mean QOLIE-10 score was 25.15. Among the 539 patients with comorbid headache, only 12.62% had received regular treatment for their headaches. A family history of headache was reported in 7.05% of cases. Inter-IH accounted for 43.23% of cases, including 58 patients (10.76%) diagnosed with migraine, 87 (16.14%) with tension-type headache, and 88 (16.32%) with other headache types. Peri-ictal headache was present in 80.89% of patients, including pre-ictal headache (Pre-IH) in 7.05% and post-ictal headache (Post-IH) in 78.48%, with no ictal headache reported. In total, 72.17% of patients reported that sleep could relieve headaches, and 19.29% had used analgesics, with non-steroidal drugs being the most common (14.47%), followed by other drug types (4.82%). The HALT-90 levels were distributed as follows: level 1 (68.09%), level 2 (13.73%), level 3 (7.98%), and level 4 (10.20%). Specific ASM use is presented in Figure 1, with levetiracetam, oxcarbazepine, and sodium valproate being the most frequently used. In this study, 7 patients (1.30%) had both Inter-IH and Pre-IH, while 112 patients (22.08%) had both Inter-IH and Post-IH. Additionally, 7 patients (1.30%) had comorbid Inter-IH, Pre-IH, and Post-IH, and 18 patients (3.34%) had both Pre-IH and Post-IH. These findings are illustrated in Figure 2. For patients with Inter-IH and Pre-IH, 42.86% reported equal pain severity between the two headache types. Among those with Inter-IH and Post-IH, 63.87% reported that Post-IH was more severe. Of those with both Pre-IH and Post-IH, 48.00% found Post-IH to be more severe. These findings are presented in Figures 3 to 5. Regarding epilepsy origin, 382 patients (70.87%) had focal epilepsy, 40 (7.42%) had generalized epilepsy, and 117 (21.71%) had epilepsy of unknown origin. Temporal lobe epilepsy was the most prevalent among focal epilepsy cases, accounting for 46.07% of these patients (Figures 6-7). The proportion of DRE was significantly higher in patients with focal epilepsy than those with epilepsy of unknown origin and generalized epilepsy (37.96% vs. 17.95%, p < 0.05; 37.96% vs. 15.00%, p < 0.05). Patients with focal epilepsy also had lower quality of life scores than those with epilepsy of unknown origin (QOLIE-10, 25.65 vs. 23.82, p < 0.05). Patients with generalized epilepsy had a higher proportion of HALT-90 level 1 than those with focal epilepsy (HALT-90, 87.50% vs. 66.23%, p < 0.05) and epilepsy of unknown origin (HALT-90, 87.50% vs. 64.96%, p < 0.05), as shown in Table 4. No significant differences were observed in the clinical characteristics of Inter-IH, Pre-IH, and Post-IH across patients with focal and generalized epilepsy and epilepsy of unknown origin (Tables 5-7). Similarly, headache classification did not significantly differ by epilepsy origin ( p > 0.05), as presented in Figure 8. Migraine comorbidity and HALT-90 were associated with DRE ( p < 0.05) (Table 8), although their accuracy in predicting DRE was low (AUC = 0.539 and AUC = 0.566, respectively), as illustrated in Figure 9. Discussion This study presents a comprehensive clinical investigation into the prevalence and characteristics of headaches in epilepsy patients. A total of 539 patients with comorbid headache and epilepsy were included, allowing for an analysis of headache types, their clinical features, and the correlation between headache characteristics and epilepsy outcomes. Headache is one of the most common comorbidities in epilepsy. Its prevalence among epilepsy patients is notably higher than in the general population. Wang et al. [ 14 ] reported that headache comorbidity in Chinese epilepsy patients reached 57.2%, compared with a population-based prevalence of 23.8%. Other studies, such as Gameleira et al. [ 15 ] and Cai et al. [ 16 ], similarly found elevated headache prevalence rates in epilepsy patients (66.1% and 41%, respectively). Notably, patients with both epilepsy and headache experience a lower quality of life than those with epilepsy alone [ 17 ]. These headaches can sometimes be more frequent, longer-lasting, and severe than the seizures themselves [ 14 ], underscoring the importance of timely diagnosis and treatment for headache comorbidity to improve patients’ quality of life. In our study, only 12.62% of patients with comorbid headache in epilepsy had received a standardized headache diagnosis, and 19.29% reported using analgesics to alleviate symptoms. These findings align with prior research. Duchaczek et al. [ 4 ] found that fewer than 40% of epilepsy patients with comorbid headache used analgesics, while Syvertsen [ 17 ] and Wawrzyniak et al. [ 18 ] reported even lower rates (11% and 4%, respectively). These findings suggest that headache comorbidity in epilepsy remains underrecognized and undertreated both in China and globally [ 19 ]. The phenomenon of multiple headache types is evident in patients with comorbid headache and epilepsy. In our study, 1.30% of patients experienced both Inter-IH and Pre-IH; 22.08% experienced both Inter-IH and Post-IH; 1.30% had Inter-IH, Pre-IH, and Post-IH; and 3.34% had both Pre-IH and Post-IH. These results are consistent with those of previous studies, which have reported associations between Inter-IH and Post-IH [ 2 ]. Ito et al. [ 3 ] found that 80% of epilepsy patients exhibit similar characteristics in Post-IH and Inter-IH, supporting a shared pathophysiological basis between these headache types [ 14 ]. Syvertsen et al. [ 17 ] further noted that migraine-like Post-IH in epilepsy patients is more often associated with migraine than other Post-IH types. In this study, different headache types showed varying levels of pain severity, with Post-IH generally being more intense than Inter-IH and Pre-IH. Literature suggests that Post-IH is more likely to involve global cerebral vasodilation than Pre-IH and Inter-IH [ 20 ], especially following generalized seizures and in cases of GTCS [ 21 ]. In terms of epilepsy origins, our study found that 70.87% of patients had focal epilepsy, compared with 7.42% with generalized epilepsy and 21.71% with unknown origins. Epilepsy origin appears to affect headache comorbidity rates. For example, a multi-center study reported that Post-IH was most frequent in occipital lobe epilepsy, occurring in 59% of cases, which was higher than in other types [ 22 ]. Gameleira et al. [ 15 ] also observed that temporal lobe epilepsy patients have higher headache prevalence than those with juvenile myoclonic epilepsy, likely due to a higher frequency of seizures in the former group. Additionally, genetic factors might contribute to variations in headache prevalence across epilepsy origins. Moreover, Gameleira et al.’s [ 15 ] study found that relatives of juvenile myoclonic epilepsy patients had a higher prevalence of headache, while other studies have identified genetic mutations, such as ATP1A2 , SCN1A , and CACNA1A , associated with both epilepsy and/or migraine [ 23 , 24 ]. Patients with focal epilepsy reported lower quality of life than those with unknown origin, consistent with prior studies indicating that more frequent seizures are associated with poorer quality of life [ 17 , 18 ]. Our findings also revealed that patients with focal epilepsy had higher seizure frequencies than those with generalized or unknown origins. However, there was no significant difference in Inter-IH frequency among epilepsy origins, suggesting that headache-related time loss may be more associated with peri-ictal headaches. Migraine is the headache type most strongly associated with epilepsy, sharing common genetic and environmental risk factors [ 23 ]. The clinical overlap between the two conditions includes similar symptoms and some shared treatments. For example, premonitory symptoms such as flash and visual defects in patients with occipital lobe epilepsy are also common premonitory symptoms of migraine [ 25 ]. Sodium valproate and topiramate, which are commonly used in ASM, are also commonly used in clinical practice to prevent migraine attacks [ 26 – 28 ]. Potential mechanisms for comorbid epilepsy and migraine include altered cortical excitability, cortical spreading depression, and elevated extracellular glutamate levels leading to cortical spreading inhibition, each contributing to the occurrence of seizures and migraines [ 20 , 23 , 29 , 30 ]. The proportion of migraine comorbidity in this study was 10.76%, If calculate the incidence based on the whole population of epilepsy patients, which is lower than those of previous reports [ 31 – 35 ]. Begasse et al. [ 34 ] reported a 21.2% prevalence of comorbid migraine in patients with focal epilepsy, and Kelley et al. [ 35 ] reported a 25% prevalence of comorbid migraine in pediatric patients. Gameleira et al. [ 15 ] reported a greater prevalence of comorbid migraine in patients with epilepsy than that of other types of headaches. However, in our study, the proportion of tension-type headache in Inter-IH was higher than that of migraine. One possible explanation for this variation is that migraine prevalence may vary across ethnic groups, with lower rates observed in Asian populations than in European and American populations [ 36 ]. This phenomenon may also exist in patients with epilepsy. Our study found that comorbid migraine was associated with DRE in patients with epilepsy, which is consistent with the findings of Velioglu et al. [ 3 ], who suggested that migraine may be a predictor of DRE and could negatively impact epilepsy outcomes. In terms of headache types, peri-ictal headache was more common (80.89%) than Inter-IH (43.23%), aligning with previous findings that Post-IH is the most frequent headache type in epilepsy. Karaali-Savrun et al. [ 37 ] reported that up to 58.51% of patients experience peri-ictal headache. Duchaczek et al. [ 4 ] also highlighted that peri-ictal headache is a common type of comorbid headache in patients with epilepsy, with Post-IH being more prevalent [ 2 ]. Peri-ictal headache may be related to the type of attack, as Ito [ 3 ] and Botha et al. [ 38 ] suggested that peri-ictal headache is more common in patients with generalized seizures. Duko et al. [ 2 ] further proposed that Pre-IH and Post-IH were more common in patients with GTCS episodes than in those without these episodes. Our study's high prevalence of GTCS (84.23%) further supports the relationship between GTCS episodes and Post-IH. Among peri-ictal headaches, Post-IH was more prevalent (78.48%) than Pre-IH (7.05%), consistent with previous findings by Wang et al. [ 14 ], who observed higher rates of Post-IH (34.1%) than Pre-IH (4.5%) in epilepsy patients, indicating that seizures can trigger headache [ 11 ]. Although the exact pathophysiology of Post-IH is unclear, it may be related to post-seizure vasodilatation [ 21 ]. Notably, no ictal headache was reported in this study, possibly because patients experienced disturbances of consciousness during seizures and could not assess headache symptoms at that time. Tension-type headache-like Post-IH was more common (34.69%) than migraine-like Post-IH (12.06%), contrasting with the results of previous studies on the nature of Post-IH. Schon et al. [ 39 ] also proposed that Post-IH is often accompanied by migraine-like symptoms, such as vomiting, photophobia, and phonophobia. Duko et al. [ 2 ] found that more than 60% of patients with Post-IH exhibit distinct migraine features. Syvertsen et al. [ 17 ] also reported that seizures often cause headaches with migraine-like features. The discrepancy in findings may arise from variations in the duration criteria for migraine-like headaches across studies [ 40 ]. Duchaczek et al. [ 4 ] also identified predictors of Post-IH, including young age at seizure onset, comprehensive ASM treatment, and GTCS episodes, while Caprara et al. [ 41 ] suggested a family history of migraine as an additional risk factor. This study found no differences in the clinical characteristics of comorbid headaches among patients with different epilepsy origins, in contrast to some prior studies. For instance, Syvertsen et al. [ 17 ] suggested that unilateral headaches in epilepsy patients could be a lateralizing sign of focal epilepsy, a finding not corroborated in this study. Further research is needed to explore the relationship between epilepsy origin and headache laterality. In conclusion, focal epilepsy with comorbid headache is the most common type observed and is associated with a lower quality of life than epilepsy with unknown origin. However, clinical characteristics of comorbid headaches do not significantly differ across epilepsy origins, and patients with generalized-origin epilepsy experience the least time loss. Post-IH is the most common comorbid headache type, and both migraine and HALT-90 levels are associated with DRE, although their predictive accuracy remains low. Declarations Author contributions SZ designed and conceived the experiment. ZL collected and analysed the data. SZ, JL, DZ drafted and revised the manuscript. All authors have read and approved the final manuscript to be published. Ethics approval and consent to participate The protocol conformed to the principles of the declaration of Helsinki and was approved by the institutional review board of West China Hospital of Sichuan University with the reference number 2022301. Written informed consent was obtained from all patients. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding This publication was supported by the hospital-level project of Affiliated Hospital of Southwest Medical University (the reference number: 24063). Acknowledgements We thank all participants for their participation. References Scheffer IE, Berkovic S, Capovilla G, et al. 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Preventive Migraine Treatment. Continuum. 2015;21:973–89. Von Brevern M, Lempert T. Vestibular Migraine: Treatment and Prognosis. Semin Neurol. 2020;40:83–6. Silberstein SD, Holland S, Freitag F, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337–45. Ottman R, Lipton RB. Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility? Neurology. 1996;47:918–24. Kreutzberg GW, Graeber MB, Streit WJ. Neuron-glial relationship during regeneration of motorneurons. Metab Brain Dis. 1989;4:81–5. Mutlu A. Association between epilepsy and headache. Neurol Sci. 2018;39:2129–34. Mainieri G, Cevoli S, Giannini G, et al. Headache in epilepsy: prevalence and clinical features. J Headache Pain. 2015;16:556. HELP Study Group. Multi-center study on migraine and seizure-related headache in patients with epilepsy (2010). Yonsei Med J 51: 219–24. Begasse de Dhaem OAJ, French J, Morrison C, et al. Migraine comorbidity and cognitive performance in patients with focal epilepsy. Epilepsy Behav. 2019;97:29–33. Kelley SA, Hartman AL, Kossoff EH. Comorbidity of migraine in children presenting with epilepsy to a tertiary care center. Neurology. 2012;79:468–73. Woldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2017;372:307–15. Karaali-Savrun F, Göksan B, Yeni SN, et al. Seizure-related headache in patients with epilepsy. Seizure. 2002;11:67–9. Botha SS, Schutte CM, Olorunju S, et al. Postictal headache in South African adult patients with generalised epilepsy in a tertiary care setting: a cross-sectional study. Cephalalgia. 2010;30:1495–501. Schon F, Blau JN. Post-epileptic headache and migraine. J Neurol Neurosurg Psychiatry. 1987;50:1148–52. Verrotti A, Coppola G, Spalice A, et al. Peri-ictal and inter-ictal headache in children and adolescents with idiopathic epilepsy: a multicenter cross-sectional study. Childs Nerv Syst. 2011;27:1419–23. Caprara F, Letícia A, Rissardo JP, et al. Characteristics of Post-Ictal Headaches in Patients with Epilepsy: a Longitudinal Study. Seizure. 2020;81:244–9. Tables Table 1 The classification criteria for comorbid headache of epilepsy. Types Inter-IH: headache occurring during the seizure inter-ictal period, the onset of which is not temporally related to the onset of seizures. Peri-ictal headache Pre-IH: headache was present within 24 hours before seizure and continued until seizure onset. Ictal headache: headache occurring at the time of seizure onset that can only be evaluated in seizure types without impairment or loss of consciousness. Post-IH: headache occurring within 3 hours after a local or generalized seizure that resolves within 72 hours after the seizure. All non–peri-ictal headaches that occurred before or within 1 year after a seizure were defined as Inter-IH. Abbreviations: Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache, Post-IH = post-ictal headache. Table 2 Classification of Inter-IH Types 1.Migraine without aura at least five episodes meeting the characteristics of (2)-(4); headache attacks (untreated or refractory to treatment) last from 4 to 72 hours; at least two of the following features of the headache: 1) unilateral 2) throbbing 3) moderate or severe pain 4) daily activities (e.g., walking or walking upstairs) worsen the headache or avoids such activities when headache attacks; the headache was accompanied by at least one of the following: 1) nausea and/or vomiting; 2) photophobia and phonophobia; headache cannot be attributed to other diseases. 2. Migraine with aura at least two episodes meeting the characteristics of (2)-(4); aura to at least one of the following kinds of performance, but there were no symptoms of motor weakness: 1) completely reversible visual symptoms, including positive performance (such as flash, bright spot, or bright line) and (or) negative performance (such as visual field defect) 2) completely reversible paresthesia, including positive performance (such as tingling) and (or) negative performance (such as numbness) 3) fully reversible speech dysfunction; at least two of the following criteria were met: 1) the same direction of visual symptoms and/or unilateral sensory symptoms; 2) at least one aura symptom developed gradually for more than 5 minutes, and (or) different aura symptoms occurred in succession for more than 5 minutes 3) each aura symptom lasted for 5-60 minutes; headache occurs at the same time as aura symptoms or within 60 minutes after the onset of aura, and the headache meets items (2)-(4) of the diagnostic criteria for migraine without aura. headache cannot be attributed to other diseases. 3. Tension-type headache at least 10 episodes meeting the characteristics of (2)-(4), a month on average onset time < 15 days; each headache attack lasts from 30 minutes to 7 days; the headache has at least two of the following features: 1) bilateral 2) pressing or tightening 3) mild or moderate pain 4) daily activities (e.g., walking or walking upstairs) not add headaches; absence of nausea or vomiting 2) absence of both photophobia and phonophobia (there can be one); headache cannot be attributed to other diseases. Abbreviations: Inter-IH = inter-ictal headache. Table 3Population characteristics and outcome indicators N Value Age (years, mean ± SD) 30.29 ± 9.97 Gender, female, n (%) 305 (56.59%) Low education, high school and below, n (%) 265 (49.17%) Age of epilepsy onset (years, mean ± SD) 18.94 ± 10.92 Epilepsy course (years, mean ± SD) 11.33 ± 9.27 Family history of epilepsy, n (%) 35 (6.49%) Epilepsy related past history, n (%) birth asphyxia 20 (3.71%) febrile convulsions 93 (17.25%) brain injury 111 (20.59%) encephalitis 10 (1.86%) brain surgery 14 (2.60%) GTCS, n (%) 454 (84.23%) Status epilepticus, n (%) 51 (9.46%) Abnormal electroencephalogram, n (%) 412 (76.44%) Abnormal head MRI, n (%） 308 (57.14%) DRE, n (%) 174 (32.28%) ASM use, n (%) monotherapy 179 (33.21%) polytherapy 298 (55.29%) no therapy 62 (11.50%) QOLIE-10, mean ± SD 25.15 ± 4.70 Had a standardized diagnosis of headache, n (%) 68 (12.62%) Family history of headache, n (%) 38 (7.05%) Inter-ictal headache, n (%) 233 (43.23%) migraine 58 (10.76%) with aura 2 (0.37%) without aura 56 (10.39%) tension-type headache 87 (16.14%) other types 88 (16.32%) Peri-ictal headache, n (%) 436 (80.89%） pre-ictal headache 38 (7.05%) migraine-like 1 (0.19%) tension-type headache-like 12 (2.23%) other types 25 (4.64%) post-ictal headache 423 (78.48%) migraine-like 65 (12.06%) tension-type headache-like 187 (34.69%) other types 171 (31.73%) Sleep can relieve headaches, n (%) 389 (72.17%) Analgesic use, n (%) 104 (19.29%) Non-steroidal anti-inflammatory drug 78 (14.47%) other 26 (4.82%) HALT-90, n (%) level 1 367 (68.09%) level 2 74 (13.73%) level 3 43 (7.98%) level 4 55 (10.20%) Classification standards of HALT-90 are as follows: level 1 (rarely): 0-5 days; level 2 (mild): 6-10 days; level 3 (moderate, indicating a serious need for care): 11-20 days; level 4 (severe, indicating serious need for care) ≥ 20 days. Abbreviations: N = number, SD = standard deviation, GTCS = generalized tonic-clonic seizures, MRI = magnetic resonance imaging, ASM = antiseizure medications, QOLIE-10 = quality of life in epilepsy inventory-10, HALT-90 = headache-attributed lost time-90 days. Table 4 Clinical characteristics of patients with epilepsy of different origins with comorbid headache n Focal origin epilepsy (Group 1) 382 Generalized origin epilepsy （Group 2） 40 Unknown origin epilepsy （Group 3） 117 p value Comparison between groups DRE, n (%) 145（37.96%） 6（15.00%） 21（17.95%） <0.001 1vs.2,1vs.3 Family history of headache, n(%) 26（3.81%） 3（7.50%） 9（7.69%） 0.847 - Types of seizures, n (%) <0.001 - partial seizures 57（14.92%） 0 8（6.84%） 1vs.2 generalized seizures 139（36.39） 40（100.00%） 86（73.50%） 1vs.2,1vs.3,2vs.3 multiple seizure types 186（48.69%） 0 23（19.66%） 1vs.2,1vs.3,2vs.3 GTCS, n (%) 313（81.94%） 35（87.50%） 106（90.60%） 0.066 - Frequency of seizures, n (%) # <0.001 - ≥1 time/week 88（23.04%） 2（5.00%） 4（3.42%） - ≥1 time/month，＜ 1 time/week 118（30.89%） 6（15.00%） 28（23.93%） - ≥1 time/year，＜ 1 time/month 129（33.77%） 22（55.00%） 64（54.70%） 1vs.2, 1vs.3 ＜1 time/year 47（12.30%） 10（25.00%） 21（17.95%） 1vs.2, 1vs.3 ASM use, n (%) 0.115 - Monotherapy 118（30.89%） 17（42.50%） 46（39.32%） - Polytherapy 224（58.64%） 19（47.50%） 54（46.15%） - No therapy 40（10.47%） 4（10.00%） 17（14.53%） - QOLIE-10, mean ± SD 25.65 ± 4.70 24.23 ± 4.80 23.82 ± 4.34 <0.001 1vs.3 Inter-IH, n (%) 170（44.50%） 16（40.00%） 47（40.17%） 0.669 - Pre-IH, n (%) 26（6.81%） 4（10.00%） 8（6.84%） 0.688 - Post-IH, n (%) 299（78.27%） 31（77.50%） 93（79.49%） 0.937 - Analgesic use, n (%) 69（18.06%） 8（20.00%） 22（5.76%） 0.913 - HALT-90 0.034 - level 1 253 (66.23%) 35（87.50%） 76（64.96%） 1vs.2,2vs.3 level 2 51（13.35%） 3（7.50%） 21（17.95%） - level 3 32（8.38%） 2（5.00%） 12（10.26%） - level 4 46（12.04%） 0 8（6.84%） - Classification standards are as follows: level 1 (rarely): 0-5 days; level 2 (mild): 6-10 days; level 3 (moderate, indicating a serious need for care): 11-20 days; level 4 (severe, indicating a serious need for care) ≥20 days; #: When patients had more than one seizure form, the frequency of the most frequent seizure form was calculated. Abbreviations: n = number, DRE = Drug-refractory epilepsy, SD = standard deviation, GTCS = generalized tonic-clonic seizures, ASM = antiseizure medications, QOLIE-10 = quality of life in epilepsy inventory-10, Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache, Post-IH = post-ictal headache, HALT-90 = headache-attributed lost time-90 days. Table 5 Comparison of Inter-IH in patients with epilepsy of different origins n Focal origin epilepsy 170 Generalized origin epilepsy 16 Unknown origin epilepsy 47 p value Duration of headache, n (%) ≤1 minute 10（5.88%） 1（6.25%） 3（6.38%） 0.974 ＞1minute ≤ 1hour 44（25.88%） 6（37.50%） 13（27.66%） ＞1hour ≤ 24 hour 97（57.06%） 7（43.75%） 26（55.32%） ＞24 hour 19（11.18%） 2（12.50%） 5（10.64%） Pain degree, n (%) 0.197 mild 50（29.41%） 5（31.25%） 16（34.04%） moderate 102（60.00%） 11（68.75%） 22（46.81%） severe 18（10.59%） 0 9（19.15%） Location of headache, n (%) 0.516 unilateral 54（31.76%） 7（43.75%） 11（23.40%） bilateral 102（60.00%） 7（43.75%） 32（68.09%） unilateral or bilateral 14（8.24%） 2（12.50%） 4（8.51%） Quality, n (%) 0.145 pulsating 16（9.41%） 3（18.75%） 10（21.28%） pressing/tightening 70（41.18%） 3（18.75%） 17（36.17%） other 58（34.12%） 5（31.25%） 13（27.66%） mixed 26（15.29%） 5（31.25%） 7（14.89%） Accompanying symptoms, n (%) nausea 40（23.53%） 5（31.25%） 15（31.91%） 0.373 emesis 8（4.71%） 2（12.50%） 3（6.38%） 0.288 photophobia 26（15.29%） 3（18.75%） 9（19.15%） 0.709 phonophobia 34（20.00%） 4（25.00%） 11（23.40%） 0.757 Aggravation by moderate physical activity, n (%) 55（32.35%） 4（25.00%） 21（44.68%） 0.229 Headache frequency, n (%) 0.248 everyday 8（2.09%） 0 4（3.42%） several times/week 33（8.64%） 2（5.00%） 3（2.56%） several times/month 70（18.32%） 6（15.00%） 24（20.51%） several times/year 59（15.45%） 8（20.00%） 16（13.68%） Abbreviations: n = number, Inter-IH = inter-ictal headache. Table 6 Comparison of Pre-IH in patients with epilepsy of different origins n Focal origin epilepsy 26 Generalized origin epilepsy 4 Unknown origin epilepsy 8 p value Duration of headache，n (%) 0.741 ≤1 minute 4（15.38%） 0（%） 1（12.50%） ＞1minute ≤ 1hour 11（42.31%） 3（75.00%） 3（37.50%） ＞1hour ≤ 24 hour 11（42.31%） 1（25.00%） 4（50.00%） Pain degree，n (%) 1.000 mild 8（30.77%） 1（25.00%） 2（25.00%） moderate 15（57.69%） 3（75.00%） 5（62.50%） severe 3（11.54%） 0 1（12.50%） Location of headache，n(%) 1.000 unilateral 7（26.92%） 1（25.00%） 0 bilateral 17（65.38%） 3（75.00%） 8（100.00%） unilateral or bilateral 2（7.69%） 0 0 Quality，n (%) 0.679 pulsating 2（7.69%） 0 0 pressing/tightening 9（34.62%） 2（50.00%） 4（50.00%） other 10（38.46%） 2（50.00%） 4（50.00%） mixed 5（19.23%） 0 0 Accompanying symptoms，n (%) nausea 4（15.38%） 1（25.00%） 1（12.50%） 0.809 emesis 0 0 0 - photophobia 2（7.69%） 0 2（25.00%） 0.234 phonophobia 3（11.54%） 0 1（12.50%） 1.000 Aggravation by moderate physical activity，n (%) 8（30.77%） 1（25.00%） 1（12.50%） 0.735 Headache frequency*，n(%) 0.251 always 18（69.23%） 3（75.00%） 4（50.00%） often 2（7.69%） 1（25.00%） 0 sometimes 6（23.08%） 0 4（50.00%） *：Frequency was classified as: always, occurring after every seizure; often, occurring after more than two-thirds of seizures; sometimes, occurring after less than half of seizures. Abbreviations: n = number, Pre-IH = pre-ictal headache. Table 7 Comparison of Post-IH in patients with epilepsy of different origins Focal origin epilepsy Generalized origin epilepsy Unknown origin epilepsy p value n 299 31 93 Duration of headache，n (%) 0.390 ≤1 minute 5（1.67%） 0（%） 2（2.15%） ＞1minute ≤ 1 hour 72（24.08%） 8（25.81%） 13（13.98%） ＞1hour ≤ 24 hours 197（65.89%） 21（67.74%） 66（70.97%） ＞24 hours 25（8.36%） 2（6.45%） 12（12.90%） Pain degree，n (%) 0.508 mild 52（17.39%） 6（19.35%） 15（16.13%） moderate 179（59.87%） 22（70.97%） 60（64.52%） severe 68（22.74%） 3（9.68%） 18（19.35%） Location of headache，n (%) 0.113 unilateral 54（18.06%） 4（12.90%） 7（7.53%） bilateral 229（76.59%） 25（80.65%） 83（89.25%） unilateral or bilateral 16（5.35%） 2（6.45%） 3（3.23%） Quality，n (%) 0.335 pulsating 12（4.01%） 1（3.23%） 8（8.60%） pressing/tightening 152（50.84%） 13（41.94%） 52（55.91%） other 102（34.11%） 12（38.71%） 25（26.88%） mixed 33（11.04%） 5（16.13%） 8（8.60%） Accompanying symptoms，n (%) nausea 75（25.08%） 8（25.81%） 29（31.18%） 0.514 emesis 31（10.37%） 1（3.23%） 7（7.53%） 0.430 photophobia 21（7.02%） 1（3.23%） 8（8.60%） 0.655 phonophobia 32（10.70%） 1（3.23%） 17（18.28%） 0.053 Aggravation by moderate physical activity，n (%) 113（37.79%） 7（22.58%） 40（43.01%） 0.123 Headache frequency*, n (%) 0.367 always 239（79.93%） 27（87.10%） 79（84.95%） often 9（3.01%） 2（6.45%） 3（3.23%） sometimes 51（17.06%） 2（6.45%） 11（11.83%） *：Frequency was classified as always, occurring after every seizure; often, occurring after more than two-thirds of seizures; and sometimes, occurring after less than half of seizures. Abbreviations: n = number, Post-IH = post-ictal headache. Table 8 Headache characteristics and related analysis with DRE Risk factor OR（95% CI） P value Comorbid multiple headaches 1.419 (0.930-2.167) 0.105 Duration of headache 0.990 (0.980-1.001) 0.064 Comorbid migraine 0.284 (0.123-0.652) 0.003 HALT-90 1.011 (1.001-1.021) 0.032 Severity of headache 0.997 (0.881-1.12) 0.958 The longest headache duration and most severe headache severity were calculated when patients had multiple comorbid headache types. Abbreviations: OR = odds ratio, CI = confidence interval, HALT-90 = headache-attributed lost time-90 days. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5752176","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399535811,"identity":"3c798bc4-037e-4c2c-846b-ead37f1eb4eb","order_by":0,"name":"Shujiang Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfv7m4z8kKmzk+NkbiNQiOeNYgoTFmTRjyZ4DRGoxOJBjIFHZdjjR4EYC0VrOGBjcbGNOYLj5eOMNhhqbaMIOO9xWkDjjHFse4+y0YguGY2m5DYS08B04vOGwRBlPMbN0jpkEY8NhwloYDiQYNv9hk0hskzxDpBaBAynGDBJtBok9EjxEagEGchqDxJkEYwkeoF8SiPELMCqPMUhU/JezP354440PNTZE+AUJGEgkkKIcooVUHaNgFIyCUTAyAACCxEMPU/OclwAAAABJRU5ErkJggg==","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shujiang","middleName":"","lastName":"Zhang","suffix":""},{"id":399535812,"identity":"f58a5b76-2e63-4244-8bc2-dc26f19daee5","order_by":1,"name":"Zhiyu Lv","email":"","orcid":"","institution":"The Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhiyu","middleName":"","lastName":"Lv","suffix":""},{"id":399535813,"identity":"d463da97-b18b-4a28-8fe6-00693f61d016","order_by":2,"name":"Jinmei Li","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jinmei","middleName":"","lastName":"Li","suffix":""},{"id":399535816,"identity":"77f951e4-4b25-40fc-8156-3346714d3c02","order_by":3,"name":"Dong Zhou","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2025-01-02 13:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5752176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5752176/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-025-04217-1","type":"published","date":"2025-05-26T15:57:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73671759,"identity":"aea10252-0c96-40c9-879b-47cc392dc9e9","added_by":"auto","created_at":"2025-01-13 12:45:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11290,"visible":true,"origin":"","legend":"\u003cp\u003eDetails of ASM use in patients with epilepsy comorbid headache\u003c/p\u003e\n\u003cp\u003eAbbreviation: ASM = anti-seizure medicine.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/97cbf6427d3afd6e3afdbccb.png"},{"id":73671762,"identity":"30b82d27-ffb7-4cab-889d-ea7241edaa18","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":76670,"visible":true,"origin":"","legend":"\u003cp\u003eVenn diagram of Inter-IH, Pre-IH, and Post-IH overlap in the total population\u003c/p\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache, Post-IH = post-ictal headache.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/280975e8905ce338926e5813.png"},{"id":73673165,"identity":"d966b47a-5008-4401-a5b1-583e741f8006","added_by":"auto","created_at":"2025-01-13 12:53:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34478,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of pain levels between the Inter-IH and Pre-IH groups\u003c/p\u003e\n\u003cp\u003eThe proportion of patients experiencing an equal degree of pain between Inter-IH and Pre-IH was the highest at 42.86%. In 35.71% of patients, the pain level of Inter-IH was lighter than that of Pre-IH, while in 21.43% of patients, the pain level of Inter-IH was heavier than that of Pre-IH.\u003c/p\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/7e3efd02f715874a2cb42098.png"},{"id":73671763,"identity":"6d5c46db-efe5-4cd8-acef-a8da1f35d7e6","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":35016,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of pain levels between the Inter-IH and Post-IH groups\u003c/p\u003e\n\u003cp\u003eThe pain severity of Post-IH was greater than that of Inter-IH in 63.87% of patients. In 20.17% of patients, the pain severity of Post-IH was equal to that of Inter-IH, while in 15.97% of patients, the pain severity of Post-IH was less than that of Inter-IH.\u003c/p\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache, Post-IH = post-ictal headache.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/7babd8472472b790ad1cf363.png"},{"id":73671765,"identity":"077afcfd-7d1a-4b7c-99d6-7f5a27582ea7","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":36038,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of pain levels between the Pre-IH and Post-IH groups\u003c/p\u003e\n\u003cp\u003eThe severity of Post-IH was greater than that of Pre-IH in 48.00% of patients. In 28.00% of patients, the severity of Pre-IH and Post-IH was equal, while in 24.00% of patients, the severity of Post-IH was less than that of Pre-IH.\u003c/p\u003e\n\u003cp\u003eAbbreviations: Pre-IH = pre-ictal headache, Post-IH: post-ictal headache.\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/214df09bbfca016091d03435.png"},{"id":73671769,"identity":"285844c8-c1fc-4f19-a014-cb4b487c4ca6","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":28202,"visible":true,"origin":"","legend":"\u003cp\u003eThe origins of epilepy in patients with comorbid headache\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/25423a9d230d5eb3278c1353.png"},{"id":73671781,"identity":"cb4609fa-bcd2-4d4d-9259-aab5a5913630","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":39917,"visible":true,"origin":"","legend":"\u003cp\u003eDetails on the origin of focal epilepsy in patients with comorbid headache\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/e33d63d849d4de12114511be.png"},{"id":73671764,"identity":"ed05cc4e-0e4b-4fb6-acec-83d4cd667787","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":12144,"visible":true,"origin":"","legend":"\u003cp\u003eCharacteristics of comorbid headache compared according to the origin of epilepsy\u003c/p\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache, Post-IH = post-ictal headache.\u003c/p\u003e","description":"","filename":"image8.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/7a38d7beac08e8dbb65632be.png"},{"id":73671772,"identity":"746308c2-e21e-4278-b53f-3f05e5f4990e","added_by":"auto","created_at":"2025-01-13 12:45:13","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":37881,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of headache characteristics to predict DRE\u003c/p\u003e\n\u003cp\u003e(A) The ROC results showed that the accuracy of comorbid migraine in predicting DRE was low, with an AUC value of 0.539; (B) the ROC results showed that the accuracy of HALT-90 in predicting DRE was also low, with an AUC value of 0.566.\u003c/p\u003e\n\u003cp\u003eAbbreviations: ROC = receiver operating curve, AUC = area under curve, HALT-90 = headache time loss index-90 days, DRE = drug-refractory epilepsy.\u003c/p\u003e","description":"","filename":"image9.png","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/14a22a98d2df94ecef7dfaf3.png"},{"id":83784068,"identity":"14193146-c011-435c-b7c5-95831bbc7698","added_by":"auto","created_at":"2025-06-02 16:20:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1345157,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5752176/v1/9c614604-6f7a-43c1-bc81-02b8093f21c6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics of epilepsy patients with comorbid headache: experience from a tertiary epilepsy center","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEpilepsy is a common neurological disorder marked by recurrent seizures, which significantly impact the physical and mental well-being of patients and are a focus of global neurological research. Comorbid conditions associated with epilepsy have become an important area of study, and in 2017, the International League Against Epilepsy (ILAE) emphasized the need to identify and manage these comorbidities in its updated classification criteria [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Headache is one of the most frequently reported comorbidities in epilepsy, though studies show variation in the epidemiology of comorbid headaches across different countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The mechanisms linking headache and epilepsy, however, remain largely unknown.\u003c/p\u003e \u003cp\u003eComorbid headaches in epilepsy can significantly reduce quality of life, and headache symptoms often exacerbate negative emotions in epilepsy patients, further affecting their overall well-being [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite these impacts, comorbid headaches in epilepsy patients often go undiagnosed and untreated, underscoring the importance of studying the clinical characteristics of these headaches and exploring their potential relationship with epilepsy prognosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHeadache comorbidities in epilepsy are categorized based on their timing in relation to seizures into peri-ictal headaches, which occur around the time of a seizure (including pre-ictal [Pre-IH], ictal, and post-ictal [Post-IH) headaches), and inter-ictal headaches, which occur independently of seizure activity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Some patients experience multiple types of headaches, and the characteristics of these headaches may vary depending on the epilepsy origin.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to investigate differences in headache comorbidities across various types of epilepsy origins and compare pain levels among epilepsy patients with multiple comorbid headache types. Additionally, we explored the potential association between headache characteristics and epilepsy prognosis.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis study enrolled inpatients and outpatients with epilepsy and comorbid headache from the Epilepsy Center at the West China Hospital of Sichuan University between June 2021 and June 2022. The study received approval from the Institutional Review Board of the West China Hospital of Sichuan University (approval number 2022301). Written informed consent, in line with the Declaration of Helsinki, was obtained from all participants after providing them with detailed information about the study.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy objectives\u003c/h2\u003e \u003cp\u003eDiagnostic criteria for epilepsy: Diagnosis was based on the 2014 ILAE Clinical Practical Definition of Epilepsy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A diagnosis of epilepsy was made if any of the following conditions were met: (1) at least two unprovoked (or reflex) seizures occurring more than 24 hours apart; (2) one unprovoked (or reflex) seizure with a risk of recurrence within 10 years comparable to that after two unprovoked seizures (60%); or (3) diagnosis of an epilepsy syndrome. Inclusion criteria: Participants were eligible if they were (1) over 18 years of age; (2) had epilepsy for more than 6 months; (3) had complete clinical data, including a 24-hour electroencephalogram and brain magnetic resonance imaging (MRI); (4) experienced headache symptoms during their epilepsy (Inter-IH, Pre-IH, ictal headache, or Post-IH); and (5) agreed to participate in the study, undergo a structured interview, and complete a questionnaire. Exclusion criteria: Participants were excluded if they (1) had cognitive impairments or mental illnesses that prevented them from completing the questionnaire; (2) had incomplete clinical data; (3) submitted incomplete questionnaires; or (4) declined to participate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003ePatients were enrolled consecutively, informed of the study's purpose, content, and procedures, and assured of voluntary participation and privacy protection. Informed consent was obtained from all participants. Data collected included demographics, epilepsy history, and headache characteristics. Pain severity was measured using the visual analog scale (VAS). The Headache-Attributed Lost Time-90 Days (HALT-90) questionnaire assessed headache-related time loss, while the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) evaluated quality of life. The accuracy of completed questionnaires was verified on the day of the interview, and questionnaires with missing or incorrect information were excluded. Two neurology specialists reviewed the data, reaching consensus through consultation when necessary.\u003c/p\u003e\n\u003ch3\u003eDemographic data and lifestyle questionnaire\u003c/h3\u003e\n\u003cp\u003eThe questionnaire gathered the following information: (1) basic details such as name, age, sex, and education level (illiterate/primary school/junior high school/senior high school/college/bachelor's degree/master's degree/doctor's degree/postdoctoral); (2) epilepsy information, including age at onset, disease course, family history, history of birth asphyxia or febrile seizures, brain trauma, encephalitis, or surgery, seizure type and frequency, status epilepticus history, electroencephalogram (EEG), brain MRI findings, antiseizure medication (ASM) use, and QOLIE-10; and (3) headache-related information, such as family history of headache, headache type (Inter-IH, Pre-IH, ictal headache, or Post-IH), headache characteristics, location (unilateral or bilateral), inter-ictal headache with or without aura, duration and frequency, response to sleep, analgesic use, VAS, and HALT-90.\u003c/p\u003e \u003cp\u003eThe QOLIE-10 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] includes the following 10 items: (1) are you energetic? (responses: all of the time, most of the time, some of the time, rarely, and never; scored from 1 to 5 points, respectively); (2) do you feel depressed (scored the same as item 1); (3) is epilepsy or ASM causing your driving impairment? (scored the same as item 1); for items 4\u0026ndash;8, respondents are asked how often they have been troubled by the following situations in the past 4 weeks: (4) memory impairment (responses: not bothered at all, rarely bothered, some of the time, a lot of the time, extremely bothered; scored from 1 to 5 points, respectively); (5) work limitation (scored the same as item 4); (6) social function limitation (scored the same as item 4); (7) physical effects of ASM (adverse reactions) (scored the same as item 4); (8) effects of ASM (scored the same as item 4); (9) how afraid are you of having a seizure next month? (responses: not at all, average, moderate, very afraid, extremely afraid; scored from 1 to 5 points, respectively); (10) What was your quality of life during the past 4 weeks? (responses: excellent, very good, mixed, fairly bad, very bad; scored from 1 to 5 points, respectively). A higher total score indicates a worse quality of life for the patient.\u003c/p\u003e \u003cp\u003eHALT-90 calculation rules [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]: (1) How many days in the past 3 months have you been unable to go to work or school because of a headache? (2) How many days in the past 3 months have you had a headache that partially affected your work or school (decreased productivity by more than half)? (3) How many days in the past 3 months have you been unable to do housework because of your headache? (4) How many days during the past 3 months did you have a headache that partially prevented you from doing housework? (5) In the past 3 months, how many days did you miss visiting family and friends, parties, entertainment such as watching movies and playing cards because of your headache? The assessment criteria are as follows: level 1 (rarely): 0\u0026ndash;5 days; level 2 (mild or infrequent): 6\u0026ndash;10 days; level 3 (moderate, indicating a need for care): 11\u0026ndash;20 days; level 4 (severe, indicating a great need for care)\u0026thinsp;\u0026ge;\u0026thinsp;20 days.\u003c/p\u003e\n\u003ch3\u003eAssessment of epilepsy-related information\u003c/h3\u003e\n\u003cp\u003eEpilepsy-related data, including seizure classification, head MRI and EEG findings, ASM use, seizure frequency, and drug-refractory epilepsy (DRE) status, were assessed by two specialists based on the ILAE criteria. Epilepsy was classified by origin (focal, generalized, or unknown) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Frequent seizures were defined as occurring\u0026thinsp;\u0026ge;\u0026thinsp;1 time per month.\u003c/p\u003e \u003cp\u003eDRE was defined per the ILAE 2010 criteria [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] as a failure to remain seizure-free after at least two appropriately chosen and well-tolerated ASM regimens, used either alone or in combination. The patient's seizure-free time did not exceed three times or 1 year (whichever was longer) of the longest seizure interval compared with before treatment.\u003c/p\u003e \u003cp\u003eStatus epilepticus was defined according to the 2001 ILAE position paper [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which is defined as a seizure that lasts longer than typical seizures in most patients with the same seizure type, showing no signs of stopping or recurring seizures, and during which the state of consciousness does not return to baseline. It generally refers to (1) any seizure lasting more than 5 minutes, (2) more than two seizures without full recovery of consciousness, (3) seizures during which consciousness does not return to baseline, (4) partial seizures lasting more than 10 minutes, or (5) absence of seizures lasting more than 15 minutes.\u003c/p\u003e\n\u003ch3\u003eHeadache comorbidity related definitions\u003c/h3\u003e\n\u003cp\u003eThe classification criteria [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] for epilepsy-related headache comorbidities were based on established guidelines. Inter-ictal headaches were classified according to the International Classification of Headache Disorders-3rd Edition (ICHD-III) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] as migraines, tension-type headaches, or other types (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Peri-ictal headaches were further characterized by migraine-like or tension-type headache-like based on diagnostic criteria.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eObservation index\u003c/h2\u003e \u003cp\u003eMain outcome measures: To examine the composition of comorbid headaches in epilepsy patients and analyze clinical differences in headache types across different epilepsy origins.\u003c/p\u003e \u003cp\u003eSecondary outcome measures: To explore the correlation between headache characteristics and DRE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using SPSS 25.0 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ibm.com/cn-zh/spss\u003c/span\u003e\u003cspan address=\"http://www.ibm.com/cn-zh/spss\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and image rendering using Datagraph 4.6 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://community.visualdatatools.com/datagraph/\u003c/span\u003e\u003cspan address=\"http://community.visualdatatools.com/datagraph/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNormally distributed data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, while non-normally distributed data were presented as median and interquartile range. Categorical data were presented as percentages. For statistical analysis, education levels were classified as \u0026ldquo;low\u0026rdquo; (high school and below) and \u0026ldquo;non-low\u0026rdquo; education level. To explore the differences in clinical characteristics of comorbid headache, we compared the demographic, sociological, headache-related, and epilepsy-related indicators in patients with epilepsy of different origins. A two-sided \u003cem\u003ep\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. One-way analysis of variance was used to compare normally distributed continuous variables among groups, with post-hoc correction via Bonferroni adjustment (significance level \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For non-normally distributed continuous variables, the rank-sum test was applied. Categorical variables were compared using the chi-square test or Fisher\u0026rsquo;s exact test, with Bonferroni correction for multiple comparisons when \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Logistic regression assessed the correlation between headache characteristics and epilepsy outcomes, and the predictive accuracy of headache characteristics for DRE was evaluated through receiver operating characteristic (ROC) curve analysis, calculating the area under the curve (AUC) for precision measurement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 543 epilepsy patients with comorbid headache met the study\u0026apos;s inclusion and exclusion criteria and completed the questionnaire. Of these, four questionnaires were excluded due to missing information, resulting in a final sample size of 539 patients. Details are presented in Table 3.\u003c/p\u003e\n\u003cp\u003eAmong the 539 patients, the average age was 30.29 years (range: 17-69 years), with women comprising 56.59% of the sample (305 individuals). Approximately 49.17% of participants had a high school education or below. The mean age of epilepsy onset was 18.94 years, and the average duration of epilepsy was 11.33 years. A family history of epilepsy was reported in 6.49% of patients. Generalized tonic-clonic seizures (GTCS) occurred in 84.23% of patients, while 9.46% experienced status epilepticus. Abnormalities associated with epilepsy were detected in 76.44% of patients who underwent EEG examination, while 57.14% had abnormalities on head MRI. Additionally, 32.28% of the sample met the criteria for DRE. Regarding ASM use, 33.21% of patients were on monotherapy, 55.29% were on polytherapy, and 11.50% were not taking any ASM. The mean QOLIE-10 score was 25.15.\u003c/p\u003e\n\u003cp\u003eAmong the 539 patients with comorbid headache, only 12.62% had received regular treatment for their headaches. A family history of headache was reported in 7.05% of cases. Inter-IH accounted for 43.23% of cases, including 58 patients (10.76%) diagnosed with migraine, 87 (16.14%) with tension-type headache, and 88 (16.32%) with other headache types. Peri-ictal headache was present in 80.89% of patients, including pre-ictal headache (Pre-IH) in 7.05% and post-ictal headache (Post-IH) in 78.48%, with no ictal headache reported. In total, 72.17% of patients reported that sleep could relieve headaches, and 19.29% had used analgesics, with non-steroidal drugs being the most common (14.47%), followed by other drug types (4.82%). The HALT-90 levels were distributed as follows: level 1 (68.09%), level 2 (13.73%), level 3 (7.98%), and level 4 (10.20%). Specific ASM use is presented in Figure 1, with levetiracetam, oxcarbazepine, and sodium valproate being the most frequently used.\u003c/p\u003e\n\u003cp\u003eIn this study, 7 patients (1.30%) had both Inter-IH and Pre-IH, while 112 patients (22.08%) had both Inter-IH and Post-IH. Additionally, 7 patients (1.30%) had comorbid Inter-IH, Pre-IH, and Post-IH, and 18 patients (3.34%) had both Pre-IH and Post-IH. These findings are illustrated in Figure 2.\u003c/p\u003e\n\u003cp\u003eFor patients with Inter-IH and Pre-IH, 42.86% reported equal pain severity between the two headache types. Among those with Inter-IH and Post-IH, 63.87% reported that Post-IH was more severe. Of those with both Pre-IH and Post-IH, 48.00% found Post-IH to be more severe. These findings are presented in Figures 3 to 5.\u003c/p\u003e\n\u003cp\u003eRegarding epilepsy origin, 382 patients (70.87%) had focal epilepsy, 40 (7.42%) had generalized epilepsy, and 117 (21.71%) had epilepsy of unknown origin. Temporal lobe epilepsy was the most prevalent among focal epilepsy cases, accounting for 46.07% of these patients (Figures 6-7).\u003c/p\u003e\n\u003cp\u003eThe proportion of DRE was significantly higher in patients with focal epilepsy than those with epilepsy of unknown origin and generalized epilepsy (37.96% vs. 17.95%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05; 37.96% vs. 15.00%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05). Patients with focal epilepsy also had lower quality of life scores than those with epilepsy of unknown origin (QOLIE-10, 25.65 vs. 23.82, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). Patients with generalized epilepsy had a higher proportion of HALT-90 level 1 than those with focal epilepsy (HALT-90, 87.50% vs. 66.23%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05) and epilepsy of unknown origin (HALT-90, 87.50% vs. 64.96%, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05), as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eNo significant differences were observed in the clinical characteristics of Inter-IH, Pre-IH, and Post-IH across patients with focal and generalized epilepsy and epilepsy of unknown origin (Tables 5-7). Similarly, headache classification did not significantly differ by epilepsy origin (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05), as presented in Figure 8.\u003c/p\u003e\n\u003cp\u003eMigraine comorbidity and HALT-90 were associated with DRE (\u003cem\u003ep \u0026lt;\u0026nbsp;\u003c/em\u003e0.05) (Table 8), although their accuracy in predicting DRE was low (AUC = 0.539 and AUC = 0.566, respectively), as illustrated in Figure 9.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents a comprehensive clinical investigation into the prevalence and characteristics of headaches in epilepsy patients. A total of 539 patients with comorbid headache and epilepsy were included, allowing for an analysis of headache types, their clinical features, and the correlation between headache characteristics and epilepsy outcomes.\u003c/p\u003e \u003cp\u003eHeadache is one of the most common comorbidities in epilepsy. Its prevalence among epilepsy patients is notably higher than in the general population. Wang et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported that headache comorbidity in Chinese epilepsy patients reached 57.2%, compared with a population-based prevalence of 23.8%. Other studies, such as Gameleira et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and Cai et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], similarly found elevated headache prevalence rates in epilepsy patients (66.1% and 41%, respectively). Notably, patients with both epilepsy and headache experience a lower quality of life than those with epilepsy alone [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These headaches can sometimes be more frequent, longer-lasting, and severe than the seizures themselves [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], underscoring the importance of timely diagnosis and treatment for headache comorbidity to improve patients\u0026rsquo; quality of life.\u003c/p\u003e \u003cp\u003eIn our study, only 12.62% of patients with comorbid headache in epilepsy had received a standardized headache diagnosis, and 19.29% reported using analgesics to alleviate symptoms. These findings align with prior research. Duchaczek et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] found that fewer than 40% of epilepsy patients with comorbid headache used analgesics, while Syvertsen [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and Wawrzyniak et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported even lower rates (11% and 4%, respectively). These findings suggest that headache comorbidity in epilepsy remains underrecognized and undertreated both in China and globally [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe phenomenon of multiple headache types is evident in patients with comorbid headache and epilepsy. In our study, 1.30% of patients experienced both Inter-IH and Pre-IH; 22.08% experienced both Inter-IH and Post-IH; 1.30% had Inter-IH, Pre-IH, and Post-IH; and 3.34% had both Pre-IH and Post-IH. These results are consistent with those of previous studies, which have reported associations between Inter-IH and Post-IH [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Ito et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] found that 80% of epilepsy patients exhibit similar characteristics in Post-IH and Inter-IH, supporting a shared pathophysiological basis between these headache types [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Syvertsen et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] further noted that migraine-like Post-IH in epilepsy patients is more often associated with migraine than other Post-IH types.\u003c/p\u003e \u003cp\u003eIn this study, different headache types showed varying levels of pain severity, with Post-IH generally being more intense than Inter-IH and Pre-IH. Literature suggests that Post-IH is more likely to involve global cerebral vasodilation than Pre-IH and Inter-IH [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], especially following generalized seizures and in cases of GTCS [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of epilepsy origins, our study found that 70.87% of patients had focal epilepsy, compared with 7.42% with generalized epilepsy and 21.71% with unknown origins. Epilepsy origin appears to affect headache comorbidity rates. For example, a multi-center study reported that Post-IH was most frequent in occipital lobe epilepsy, occurring in 59% of cases, which was higher than in other types [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Gameleira et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] also observed that temporal lobe epilepsy patients have higher headache prevalence than those with juvenile myoclonic epilepsy, likely due to a higher frequency of seizures in the former group. Additionally, genetic factors might contribute to variations in headache prevalence across epilepsy origins. Moreover, Gameleira et al.\u0026rsquo;s [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] study found that relatives of juvenile myoclonic epilepsy patients had a higher prevalence of headache, while other studies have identified genetic mutations, such as \u003cem\u003eATP1A2\u003c/em\u003e, \u003cem\u003eSCN1A\u003c/em\u003e, and \u003cem\u003eCACNA1A\u003c/em\u003e, associated with both epilepsy and/or migraine [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with focal epilepsy reported lower quality of life than those with unknown origin, consistent with prior studies indicating that more frequent seizures are associated with poorer quality of life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our findings also revealed that patients with focal epilepsy had higher seizure frequencies than those with generalized or unknown origins. However, there was no significant difference in Inter-IH frequency among epilepsy origins, suggesting that headache-related time loss may be more associated with peri-ictal headaches.\u003c/p\u003e \u003cp\u003eMigraine is the headache type most strongly associated with epilepsy, sharing common genetic and environmental risk factors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The clinical overlap between the two conditions includes similar symptoms and some shared treatments. For example, premonitory symptoms such as flash and visual defects in patients with occipital lobe epilepsy are also common premonitory symptoms of migraine [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Sodium valproate and topiramate, which are commonly used in ASM, are also commonly used in clinical practice to prevent migraine attacks [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Potential mechanisms for comorbid epilepsy and migraine include altered cortical excitability, cortical spreading depression, and elevated extracellular glutamate levels leading to cortical spreading inhibition, each contributing to the occurrence of seizures and migraines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe proportion of migraine comorbidity in this study was 10.76%, If calculate the incidence based on the whole population of epilepsy patients, which is lower than those of previous reports [\u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Begasse et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported a 21.2% prevalence of comorbid migraine in patients with focal epilepsy, and Kelley et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] reported a 25% prevalence of comorbid migraine in pediatric patients. Gameleira et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported a greater prevalence of comorbid migraine in patients with epilepsy than that of other types of headaches. However, in our study, the proportion of tension-type headache in Inter-IH was higher than that of migraine. One possible explanation for this variation is that migraine prevalence may vary across ethnic groups, with lower rates observed in Asian populations than in European and American populations [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This phenomenon may also exist in patients with epilepsy.\u003c/p\u003e \u003cp\u003eOur study found that comorbid migraine was associated with DRE in patients with epilepsy, which is consistent with the findings of Velioglu et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], who suggested that migraine may be a predictor of DRE and could negatively impact epilepsy outcomes.\u003c/p\u003e \u003cp\u003eIn terms of headache types, peri-ictal headache was more common (80.89%) than Inter-IH (43.23%), aligning with previous findings that Post-IH is the most frequent headache type in epilepsy. Karaali-Savrun et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] reported that up to 58.51% of patients experience peri-ictal headache. Duchaczek et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] also highlighted that peri-ictal headache is a common type of comorbid headache in patients with epilepsy, with Post-IH being more prevalent [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Peri-ictal headache may be related to the type of attack, as Ito [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and Botha et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] suggested that peri-ictal headache is more common in patients with generalized seizures. Duko et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] further proposed that Pre-IH and Post-IH were more common in patients with GTCS episodes than in those without these episodes. Our study's high prevalence of GTCS (84.23%) further supports the relationship between GTCS episodes and Post-IH.\u003c/p\u003e \u003cp\u003eAmong peri-ictal headaches, Post-IH was more prevalent (78.48%) than Pre-IH (7.05%), consistent with previous findings by Wang et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], who observed higher rates of Post-IH (34.1%) than Pre-IH (4.5%) in epilepsy patients, indicating that seizures can trigger headache [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although the exact pathophysiology of Post-IH is unclear, it may be related to post-seizure vasodilatation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Notably, no ictal headache was reported in this study, possibly because patients experienced disturbances of consciousness during seizures and could not assess headache symptoms at that time.\u003c/p\u003e \u003cp\u003eTension-type headache-like Post-IH was more common (34.69%) than migraine-like Post-IH (12.06%), contrasting with the results of previous studies on the nature of Post-IH. Schon et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] also proposed that Post-IH is often accompanied by migraine-like symptoms, such as vomiting, photophobia, and phonophobia. Duko et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] found that more than 60% of patients with Post-IH exhibit distinct migraine features. Syvertsen et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] also reported that seizures often cause headaches with migraine-like features. The discrepancy in findings may arise from variations in the duration criteria for migraine-like headaches across studies [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Duchaczek et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] also identified predictors of Post-IH, including young age at seizure onset, comprehensive ASM treatment, and GTCS episodes, while Caprara et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] suggested a family history of migraine as an additional risk factor.\u003c/p\u003e \u003cp\u003eThis study found no differences in the clinical characteristics of comorbid headaches among patients with different epilepsy origins, in contrast to some prior studies. For instance, Syvertsen et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] suggested that unilateral headaches in epilepsy patients could be a lateralizing sign of focal epilepsy, a finding not corroborated in this study. Further research is needed to explore the relationship between epilepsy origin and headache laterality.\u003c/p\u003e \u003cp\u003eIn conclusion, focal epilepsy with comorbid headache is the most common type observed and is associated with a lower quality of life than epilepsy with unknown origin. However, clinical characteristics of comorbid headaches do not significantly differ across epilepsy origins, and patients with generalized-origin epilepsy experience the least time loss. Post-IH is the most common comorbid headache type, and both migraine and HALT-90 levels are associated with DRE, although their predictive accuracy remains low.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSZ designed and conceived the experiment. ZL collected and analysed the data. SZ, JL, DZ drafted and revised the manuscript. All authors have read and approved the final manuscript to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol conformed to the principles of the declaration of Helsinki and \u0026nbsp;was approved by the institutional review board of West China Hospital of Sichuan University with the reference number 2022301. Written informed \u0026nbsp;consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available \u0026nbsp;from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the \u0026nbsp;research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis publication was supported by the hospital-level project of Affiliated Hospital of Southwest Medical University (the reference number: 24063).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all participants for their participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eScheffer IE, Berkovic S, Capovilla G, et al. 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Comorbidity of migraine in children presenting with epilepsy to a tertiary care center. Neurology. 2012;79:468\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoldeamanuel YW, Cowan RP. Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants. J Neurol Sci. 2017;372:307\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaraali-Savrun F, G\u0026ouml;ksan B, Yeni SN, et al. Seizure-related headache in patients with epilepsy. Seizure. 2002;11:67\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBotha SS, Schutte CM, Olorunju S, et al. Postictal headache in South African adult patients with generalised epilepsy in a tertiary care setting: a cross-sectional study. Cephalalgia. 2010;30:1495\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchon F, Blau JN. Post-epileptic headache and migraine. J Neurol Neurosurg Psychiatry. 1987;50:1148\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerrotti A, Coppola G, Spalice A, et al. Peri-ictal and inter-ictal headache in children and adolescents with idiopathic epilepsy: a multicenter cross-sectional study. Childs Nerv Syst. 2011;27:1419\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaprara F, Let\u0026iacute;cia A, Rissardo JP, et al. Characteristics of Post-Ictal Headaches in Patients with Epilepsy: a Longitudinal Study. Seizure. 2020;81:244\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e The classification criteria for comorbid headache of epilepsy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 559px;\"\u003e\n \u003cp\u003eTypes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 559px;\"\u003e\n \u003cp\u003eInter-IH: headache occurring during the seizure inter-ictal period, the onset of which is not temporally related to the onset of seizures.\u003c/p\u003e\n \u003cp\u003ePeri-ictal headache\u003c/p\u003e\n \u003cp\u003ePre-IH: headache was present within 24 hours before seizure and continued until seizure onset.\u003c/p\u003e\n \u003cp\u003eIctal headache: headache occurring at the time of seizure onset that can only be evaluated in seizure types without impairment or loss of consciousness.\u003c/p\u003e\n \u003cp\u003ePost-IH: headache occurring within 3 hours after a local or generalized seizure that resolves within 72 hours after the seizure.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll non\u0026ndash;peri-ictal headaches that occurred before or within 1 year after a seizure were defined as Inter-IH.\u003c/p\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache, Post-IH = post-ictal headache.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Classification of Inter-IH\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 559px;\"\u003e\n \u003cp\u003eTypes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 559px;\"\u003e\n \u003cp\u003e1.Migraine without aura\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003eat least five episodes meeting the characteristics of (2)-(4);\u003c/li\u003e\n \u003cli\u003eheadache attacks (untreated or refractory to treatment) last from 4 to 72 hours;\u003c/li\u003e\n \u003cli\u003eat least two of the following features of the headache: 1) unilateral 2) throbbing 3) moderate or severe pain 4) daily activities (e.g., walking or walking upstairs) worsen the headache or avoids such activities when headache attacks;\u003c/li\u003e\n \u003cli\u003ethe headache was accompanied by at least one of the following: 1) nausea and/or vomiting; 2) photophobia and phonophobia;\u003c/li\u003e\n \u003cli\u003eheadache cannot be attributed to other diseases.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e2. Migraine with aura\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003eat least two episodes meeting the characteristics of (2)-(4);\u003c/li\u003e\n \u003cli\u003eaura to at least one of the following kinds of performance, but there were no symptoms of motor weakness: 1) completely reversible visual symptoms, including positive performance (such as flash, bright spot, or bright line) and (or) negative performance (such as visual field defect) 2) completely reversible paresthesia, including positive performance (such as tingling) and (or) negative performance (such as numbness) 3) fully reversible speech dysfunction;\u003c/li\u003e\n \u003cli\u003eat least two of the following criteria were met: 1) the same direction of visual symptoms and/or unilateral sensory symptoms; 2) at least one aura symptom developed gradually for more than 5 minutes, and (or) different aura symptoms occurred in succession for more than 5 minutes 3) each aura symptom lasted for 5-60 minutes;\u003c/li\u003e\n \u003cli\u003eheadache occurs at the same time as aura symptoms or within 60 minutes after the onset of aura, and the headache meets items (2)-(4) of the diagnostic criteria for migraine without aura.\u003c/li\u003e\n \u003cli\u003eheadache cannot be attributed to other diseases.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e3. Tension-type headache\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003eat least 10 episodes meeting the characteristics of (2)-(4), a month on average onset time \u0026lt; 15 days;\u003c/li\u003e\n \u003cli\u003eeach headache attack lasts from 30 minutes to 7 days;\u003c/li\u003e\n \u003cli\u003ethe headache has at least two of the following features: 1) bilateral 2) pressing or tightening\u0026nbsp;3) mild or moderate pain 4) daily activities (e.g., walking or walking upstairs) not add headaches;\u003c/li\u003e\n \u003cli\u003eabsence of nausea or vomiting 2) absence of both photophobia and phonophobia\u0026nbsp;(there can be one);\u003c/li\u003e\n \u003cli\u003eheadache cannot be attributed to other diseases.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: Inter-IH = inter-ictal headache.\u003c/p\u003e\n\u003cp\u003eTable 3Population characteristics and outcome indicators\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"563\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 395px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 168px;\"\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eAge (years, mean \u0026plusmn; SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30.29 \u0026plusmn; 9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eGender, female, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e305 (56.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eLow education, high school and below, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e265 (49.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eAge of epilepsy onset (years, mean \u0026plusmn; SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e18.94 \u0026plusmn; 10.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eEpilepsy course (years, mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e11.33 \u0026plusmn; 9.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eFamily history of epilepsy, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e35 (6.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eEpilepsy related past history, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ebirth asphyxia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e20 (3.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003efebrile convulsions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e93 (17.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ebrain injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e111 (20.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eencephalitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e10 (1.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ebrain surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e14 (2.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eGTCS, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e454 (84.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eStatus epilepticus, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e51 (9.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eAbnormal electroencephalogram, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e412 (76.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eAbnormal head MRI, n (%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e308 (57.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eDRE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e174 (32.28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eASM use,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003emonotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e179 (33.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003epolytherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e298 (55.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eno therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e62 (11.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eQOLIE-10, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e25.15 \u0026plusmn; 4.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eHad a standardized diagnosis of headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e68 (12.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eFamily history of headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e38 (7.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eInter-ictal headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e233 (43.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003emigraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e58 (10.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ewith aura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (0.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ewithout aura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e56 (10.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003etension-type headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e87 (16.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eother types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e88 (16.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003ePeri-ictal headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e436 (80.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003epre-ictal headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e38 (7.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003emigraine-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 (0.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003etension-type headache-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e12 (2.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eother types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e25 (4.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003epost-ictal headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e423 (78.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003emigraine-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e65 (12.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003etension-type headache-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e187 (34.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eother types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e171 (31.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eSleep can relieve headaches, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e389 (72.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eAnalgesic use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e104 (19.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eNon-steroidal anti-inflammatory drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e78 (14.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e26 (4.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003eHALT-90, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003elevel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e367 (68.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003elevel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e74 (13.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003elevel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e43 (7.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 395px;\"\u003e\n \u003cp\u003elevel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e55 (10.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eClassification standards of HALT-90 are as follows: level 1 (rarely): 0-5 days; level 2 (mild): 6-10 days; level 3 (moderate, indicating a serious need for care): 11-20 days; level 4 (severe, indicating serious need for care) \u0026ge; 20 days.\u003c/p\u003e\n\u003cp\u003eAbbreviations: N = number, SD = standard deviation, GTCS = generalized tonic-clonic seizures, MRI = magnetic resonance imaging, ASM = antiseizure medications, QOLIE-10 = quality of life in epilepsy inventory-10, HALT-90 = headache-attributed lost time-90 days.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Clinical characteristics of patients with epilepsy of different origins with comorbid headache\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"615\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003eFocal origin epilepsy\u003c/p\u003e\n \u003cp\u003e(Group 1)\u003c/p\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eGeneralized origin epilepsy\u003c/p\u003e\n \u003cp\u003e（Group 2）\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eUnknown origin epilepsy\u003c/p\u003e\n \u003cp\u003e（Group 3）\u003c/p\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eComparison between groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eDRE, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e145（37.96%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6（15.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e21（17.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1vs.2,1vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eFamily history of headache, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e26（3.81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3（7.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9（7.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eTypes of seizures, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003epartial seizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e57（14.92%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8（6.84%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003egeneralized seizures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e139（36.39）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e40（100.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e86（73.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2,1vs.3,2vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003emultiple seizure types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e186（48.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e23（19.66%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2,1vs.3,2vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eGTCS, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e313（81.94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e35（87.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e106（90.60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eFrequency of seizures, n (%)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026ge;1 time/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e88（23.04%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2（5.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4（3.42%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026ge;1 time/month，＜\u0026nbsp;1 time/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e118（30.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6（15.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e28（23.93%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026ge;1 time/year，＜\u0026nbsp;1 time/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e129（33.77%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22（55.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e64（54.70%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2, 1vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e＜1 time/year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e47（12.30%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e21（17.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2, 1vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eASM use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eMonotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e118（30.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17（42.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e46（39.32%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003ePolytherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e224（58.64%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e19（47.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e54（46.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eNo therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e40（10.47%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4（10.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e17（14.53%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eQOLIE-10, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e25.65 \u0026plusmn; 4.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24.23 \u0026plusmn; 4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e23.82 \u0026plusmn; 4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eInter-IH, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e170（44.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16（40.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e47（40.17%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003ePre-IH, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e26（6.81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4（10.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8（6.84%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003ePost-IH, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e299（78.27%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e31（77.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e93（79.49%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eAnalgesic use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e69（18.06%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;8（20.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e22（5.76%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eHALT-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003elevel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e253 (66.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;35（87.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e76（64.96%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1vs.2,2vs.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003elevel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e51（13.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp; 3（7.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e21（17.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003elevel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e32（8.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2（5.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e12（10.26%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003elevel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 103px;\"\u003e\n \u003cp\u003e46（12.04%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8（6.84%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eClassification standards are as follows: level 1 (rarely): 0-5 days; level 2 (mild): 6-10 days; level 3 (moderate, indicating a serious need for care): 11-20 days; level 4 (severe, indicating a serious need for care) \u0026ge;20 days; #: When patients had more than one seizure form, the frequency of the most frequent seizure form was calculated.\u003c/p\u003e\n\u003cp\u003eAbbreviations: n = number, DRE = Drug-refractory epilepsy, SD = standard deviation, GTCS = generalized tonic-clonic seizures, ASM = antiseizure medications, QOLIE-10 = quality of life in epilepsy inventory-10, Inter-IH = inter-ictal headache, Pre-IH = pre-ictal headache, Post-IH = post-ictal headache, HALT-90 = headache-attributed lost time-90 days.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 Comparison of Inter-IH in patients with epilepsy of different origins\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eFocal origin epilepsy\u003c/p\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eGeneralized origin epilepsy\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eUnknown origin epilepsy\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eDuration of headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026le;1 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10（5.88%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e1（6.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e3（6.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e＞1minute \u0026le; 1hour \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e44（25.88%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e6（37.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e13（27.66%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e＞1hour \u0026le; 24 hour \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e97（57.06%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e7（43.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e26（55.32%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e＞24 hour \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e19（11.18%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e2（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e5（10.64%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePain degree, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003emild \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e50（29.41%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5（31.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e16（34.04%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003emoderate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e102（60.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e11（68.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e22（46.81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003esevere\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e18（10.59%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e9（19.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLocation of headache, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eunilateral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e54（31.76%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e7（43.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e11（23.40%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ebilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e102（60.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e7（43.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e32（68.09%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eunilateral or bilateral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e14（8.24%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e2（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e4（8.51%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eQuality, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003epulsating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e16（9.41%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e3（18.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e10（21.28%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003epressing/tightening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e70（41.18%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e3（18.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e17（36.17%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eother\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e58（34.12%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5（31.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e13（27.66%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003emixed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e26（15.29%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5（31.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e7（14.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAccompanying symptoms, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003enausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e40（23.53%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e5（31.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e15（31.91%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eemesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e8（4.71%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e2（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e3（6.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ephotophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e26（15.29%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e3（18.75%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e9（19.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ephonophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e34（20.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e4（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e11（23.40%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAggravation by moderate physical activity, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e55（32.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e4（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e21（44.68%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eHeadache frequency, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eeveryday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e8（2.09%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e4（3.42%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eseveral times/week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e33（8.64%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e2（5.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e3（2.56%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eseveral times/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e70（18.32%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e6（15.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e24（20.51%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eseveral times/year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e59（15.45%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e8（20.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e16（13.68%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: n = number, Inter-IH = inter-ictal headache.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 6 Comparison of Pre-IH in patients with epilepsy of different origins\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"541\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eFocal origin epilepsy\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eGeneralized origin epilepsy\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eUnknown origin epilepsy\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eDuration of headache，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026le;1 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4（15.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e＞1minute \u0026le; 1hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11（42.31%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3（75.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3（37.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e＞1hour \u0026le; 24 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e11（42.31%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePain degree，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003emild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8（30.77%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e15（57.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3（75.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e5（62.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003esevere \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3（11.54%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eLocation of headache，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eunilateral \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e7（26.92%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ebilateral \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e17（65.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3（75.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e8（100.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eunilateral or bilateral \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2（7.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eQuality，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003epulsating \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2（7.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003epressing/tightening\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e9（34.62%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eother \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e10（38.46%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003emixed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e5（19.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAccompanying symptoms，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003enausea\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e4（15.38%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eemesis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ephotophobia \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2（7.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ephonophobia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3（11.54%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAggravation by moderate physical activity，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e8（30.77%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eHeadache frequency*，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ealways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e18（69.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3（75.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eoften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2（7.69%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（25.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003esometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6（23.08%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4（50.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*：Frequency was classified as: always, occurring after every seizure; often, occurring after more than two-thirds of seizures; sometimes, occurring after less than half of seizures.\u003c/p\u003e\n\u003cp\u003eAbbreviations: n = number, Pre-IH = pre-ictal headache.\u003c/p\u003e\n\u003cp\u003eTable 7 Comparison of Post-IH in patients with epilepsy of different origins\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003eFocal origin epilepsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003eGeneralized origin\u0026nbsp;epilepsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUnknown origin epilepsy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eDuration of headache，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003e\u0026le;1 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e5（1.67%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e0（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e2（2.15%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003e＞1minute \u0026le; 1 hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e72（24.08%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e8（25.81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e13（13.98%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003e＞1hour \u0026le; 24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e197（65.89%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e21（67.74%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e66（70.97%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003e＞24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e25（8.36%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e2（6.45%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e12（12.90%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003ePain degree，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003emild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e52（17.39%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e6（19.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e15（16.13%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e179（59.87%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e22（70.97%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e60（64.52%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003esevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e68（22.74%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e3（9.68%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e18（19.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eLocation of headache，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eunilateral \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e54（18.06%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e4（12.90%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e7（7.53%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003ebilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e229（76.59%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e25（80.65%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e83（89.25%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eunilateral or bilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e16（5.35%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e2（6.45%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e3（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eQuality，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003epulsating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e12（4.01%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e1（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e8（8.60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003epressing/tightening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e152（50.84%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e13（41.94%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e52（55.91%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eother\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e102（34.11%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e12（38.71%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e25（26.88%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003emixed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e33（11.04%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e5（16.13%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e8（8.60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eAccompanying symptoms，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003enausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e75（25.08%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e8（25.81%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e29（31.18%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eemesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e31（10.37%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e1（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e7（7.53%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003ephotophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e21（7.02%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e1（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e8（8.60%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003ephonophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e32（10.70%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e1（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e17（18.28%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eAggravation by moderate physical activity，n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e113（37.79%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e7（22.58%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e40（43.01%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eHeadache frequency*, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003ealways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e239（79.93%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e27（87.10%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e79（84.95%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003eoften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e9（3.01%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e2（6.45%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e3（3.23%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31.758%;\"\u003e\n \u003cp\u003esometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e51（17.06%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.5255%;\"\u003e\n \u003cp\u003e2（6.45%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.0624%;\"\u003e\n \u003cp\u003e11（11.83%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.1285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*：Frequency was classified as always, occurring after every seizure; often, occurring after more than two-thirds of seizures; and sometimes, occurring after less than half of seizures.\u003c/p\u003e\n\u003cp\u003eAbbreviations: n = number, Post-IH = post-ictal headache.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 8 \u0026nbsp;Headache characteristics and related analysis with DRE\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"540\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eRisk factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eOR（95% CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eComorbid multiple headaches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e1.419 (0.930-2.167)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eDuration of headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e0.990 (0.980-1.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eComorbid migraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e0.284 (0.123-0.652)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eHALT-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e1.011 (1.001-1.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219px;\"\u003e\n \u003cp\u003eSeverity of headache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e0.997 (0.881-1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 131px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe longest headache duration and most severe headache severity were calculated when patients had multiple comorbid headache types.\u003c/p\u003e\n\u003cp\u003eAbbreviations: OR = odds ratio, CI = confidence interval, HALT-90 = headache-attributed lost time-90 days.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Comorbid headache, inter-ictal headache, pre-ictal headache, post-ictal headache, epilepsy origin","lastPublishedDoi":"10.21203/rs.3.rs-5752176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5752176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHeadache is one of the most common comorbidities in epilepsy, with affected patients experiencing various types of headaches. This study aimed to investigate differences in comorbid headache types across epilepsy origins, comparing pain levels among epilepsy patients with multiple headache types, and exploring associations between headache characteristics and epilepsy prognosis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed consecutive adult epilepsy patients with comorbid headache, collecting comprehensive sociodemographic, epilepsy-related, and headache-related data, as well as data on headache-attributed lost time and quality of life. The overall prevalence of headache comorbidity in epilepsy was determined, and we compared clinical characteristics, quality of life, and headache-attributed lost time across different epilepsy origins. Based on the temporal relationship between headache and seizures, comorbid headaches were classified into inter-ictal headache (Inter-IH), ictal headache, pre-ictal headache (Pre-IH), and post-ictal headache (Post-IH) for subgroup analysis to explore differences in clinical characteristics by headache type. We conducted multiple logistic regression and receiver operating characteristic (ROC) analyses to calculate the area under the curve (AUC), assessing correlations between headache characteristics and epilepsy prognosis and the predictive accuracy for drug-refractory epilepsy (DRE).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 539 epilepsy patients with comorbid headache were included, comprising 233 with Inter-IH (43.22%), 38 with Pre-IH (7.05%), and 423 with Post-IH (78.48%); no patients had ictal headache. Among those with Inter-IH, 58 (10.76%) met the diagnostic criteria for migraine, and 87 (16.14%) met the criteria for tension-type headache. In our cohort, 7 patients (1.30%) experienced both Inter-IH and Pre-IH, 112 (22.08%) had both Inter-IH and Post-IH, 7 (1.30%) experienced Inter-IH, Pre-IH, and Post-IH, and 18 (3.34%) had both Pre-IH and Post-IH. The study included 382 patients with focal epilepsy (70.87%), 40 with generalized epilepsy (7.42%), and 117 with epilepsy of unknown origin (21.71%), with temporal lobe epilepsy being the most common focal type, representing 46.07% of cases. Patients with focal epilepsy reported lower quality of life than those with epilepsy of unknown origin (QOLIE-10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and had a lower proportion of bilateral Post-IH than those with epilepsy of unknown origin (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The proportion of patients with level 1 Headache-Attributed Lost Time-90 Days (HALT-90) was higher in generalized epilepsy than in focal (87.50% vs. 66.23%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and unknown origin (87.50% vs. 64.96%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Comorbid migraine and HALT-90 were associated with DRE (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), although predictive accuracy was low (AUC\u0026thinsp;=\u0026thinsp;0.539; AUC\u0026thinsp;=\u0026thinsp;0.566, respectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe most common type of epilepsy with comorbid headache was focal origin, with patients experiencing poorer quality of life than those with epilepsy of unknown origin. Clinical characteristics of comorbid headaches did not vary significantly by epilepsy origin, but patients with generalized epilepsy and comorbid headache had the least time lost. Post-IH was the most common type of comorbid headache. While comorbid migraine and HALT-90 were associated with DRE, the predictive accuracy for DRE was insufficient.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics of epilepsy patients with comorbid headache: experience from a tertiary epilepsy center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 12:45:08","doi":"10.21203/rs.3.rs-5752176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-18T19:48:54+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"274581314359006259923817106492014266564","date":"2025-02-18T01:09:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-17T14:50:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-16T11:37:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145638632288138973805475808025952809178","date":"2025-02-10T10:56:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318706341370156303821626350676118883240","date":"2025-01-31T09:57:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88223754995362587787329144318923304919","date":"2025-01-29T07:58:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-29T07:54:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-17T12:03:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-08T14:37:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-07T12:54:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-01-02T13:29:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9ccf5e2d-c68c-485c-a5ae-ceb2b0d867b2","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:10:52+00:00","versionOfRecord":{"articleIdentity":"rs-5752176","link":"https://doi.org/10.1186/s12883-025-04217-1","journal":{"identity":"bmc-neurology","isVorOnly":false,"title":"BMC Neurology"},"publishedOn":"2025-05-26 15:57:27","publishedOnDateReadable":"May 26th, 2025"},"versionCreatedAt":"2025-01-13 12:45:08","video":"","vorDoi":"10.1186/s12883-025-04217-1","vorDoiUrl":"https://doi.org/10.1186/s12883-025-04217-1","workflowStages":[]},"version":"v1","identity":"rs-5752176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5752176","identity":"rs-5752176","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}