Abstract text (incl. figure legends and references)

Question: Although the pathophysiology of headache as an epileptic aura is frequently attributed to the excessive neocortical cellular excitability of the parieto-occipital cortex in patients with focal seizures, several studies have documented headache may occur as an aura or isolated epileptic symptom in patients with generalized seizures. Currently, there is limited information on the headache as an aura in patients with generalized seizures.

Methods: We performed a 14-year retrospective study of patients with generalized seizures who received at least 6 months of treatment in our epilepsy clinic. Information on the characteristics of aura and seizure semiology were obtained through review of medical records. The proportion of patients who experienced an aura including headache and the demographic and clinical characteristics of the patients with and without headache as an aura were further analyzed.

Results: We included 102 patients diagnosed with generalized seizures and received treatment for at least 6 months. The patients were 44 males and 58 females. The most frequent seizure types were absence seizures in 8 patients, myoclonic seizures in 54 patients, and generalized tonic clonic seizures in 40 patients. Aura was documented in 45 patients (45/102, 44.1%) and headache was the most common aura in 26 patients (26/102, 25.5%). There was no differences in gender, seizure type, and presence or absence of aura other than headache but patients with headache as an aura had a significantly younger age of onset of seizures than patients without headache (14.8±3.8 vs 24.7±16.2, p=0.003).

Conclusion: Our study shows that headache is the most frequent aura in patients with generalized seizures. Patients with a younger age of onset of seizures are more likely to experience headache as an aura, which may be due to differences in pathophysiology or cortical neuronal network according to the age of onset of seizures in patients with generalized seizures.