A retrospective analysis of records of 312 children with chronic headache and review of EEGs in 257 are reported from the Tel Aviv Medical Center and University, Israel. Headache was classified as migraine in 143 (55%); classic migraine in 12 and common migraine in 121. The mean age at time of EEG was 9 years. The EEG was normal in 80%. Epileptiform activity occurred in 12% and slowing in 8%. Response was higher to hyperventilation in non-migraine patients and to photic stimulation in those with migraine. The incidence of epileptic EEGs was 11% in both migraine and tension type headaches; it was 26% and significantly higher in 15 children with chronic headache described as “very brief,” occurring predominantly in girls, several times a week, and without family history for migraine. Prevalence of epilepsy in families of patients with epileptic EEGs did not differ from the total group. Of six children with epileptiform EEGs who were treated with AEDs, 4 responded and had no further headaches and 2 were not benefited. Of 17 children with focal EEG abnormalities, 9 had head CTs, 1 had an arachnoid cyst, and 3 had sinusitis. The authors conclude that the EEG may be of value in some children with migraine and “very brief” headaches, but epileptiform EEG activity does not prove an epileptic origin for headache and its significance in diagnosis and treatment is minimal. [1]

COMMENT. See Progress in Pediatric Neurology II (PNB Publ, 1994, p 156) for a report of the EEG findings in children with chronic recurrent headaches and response to phenytoin. Grade III epileptiform EEGs were found in 18% of the total and with the same incidence in migraine patients. Migraine was controlled in 77% but a positive response did not correlate with EEG abnormalities; those with normal EEGs were benefited equally [2]. The significance of the EEG in chronic headache evaluation and the mechanism of the anti-migraine effect of phenytoin and other antiepileptic drugs (eg. valproate) need further investigation.