AUTHOR=Atalar Arife Çimen , Özge Aynur , Türk Bengi Gül , Ekizoğlu Esme , Kurt Gök Duygu , Baykan Betül , Ayta Semih , Erdoğan Füsun Ferda , Yeni Seher Naz , Taşdelen Bahar ,  IDEM Study Group , Velioğlu Sibel K. , Yapıcı Zuhal , Midi İpek , Serap Saygı , Ulufer Çelebi , Sarıca Darol Elif , Ağan  Kadriye , Ayç Senem , Gazioğlu Sibel , Vildan Okudan Zeynep , Görkem Şirin Nermin , Bebek Nerses , Dericioğlu Neşe , Güçlü Altun İlknur , Destina Yalçın Ayşe ,  Sürmeli Reyhan , Osman Erdinç Oğuz , Erdal Abidin , İlhan Algın Demet , Kutlu Gülnihal , Bek Semai , Erdal Yüksel , Övünç Özön Akçay , Reyhani Aylin , Güldiken Babürhan , Baklan Barış , Oğuz Genç Bülent , Aykutlu Altindağ Ebru , Karahan Gökçen , Koç Güray , Mısırlı Handan , Öztura İbrahim , Aslan-Kara Kezban , Merve Melodi Çakar , Türkmen Nur , Bulut Onur , Ömer Karadaş , Kesim Çahin Özlem , Ferik Sevgi , Mehmet Taylan Peköz , Topaloğlu Pınar , Üstün Özek Sibel , Düzgün Ülkühan , Yayla Vildan , Gömceli Yasemin , Ünlüsoy Acar Zeynep 

TITLE=Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1103541

DOI=10.3389/fneur.2022.1103541

ISSN=1664-2295

ABSTRACT=Background: Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in diagnosis of comorbid MwoA, by using a zone concept, in patients with I/GEs with headache who were diagnosed by an experienced headache expert.
Methods: In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were re-evaluated. Eligible patients were divided into three subgroups: full diagnosis, zone I, and II according to their status of fulfilling the ICHD-3 criteria. Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis. 
Results: Longer headache duration (˃4 hours) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, having nausea/vomiting, photo and /or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in I/GE patients, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had distinguishing capability in being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n=62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% Epilepsy with Generalized Tonic-Clonic Seizures Alone .
Conclusions: Longer headache duration, throbbing pain, increase of pain by physical activity, photo and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs.  Evaluating these characteristics could be helpful to close the diagnostic gaps in the everyday clinical practice and fasten the diagnosic process of comorbid MwoA in patients with I/GEs.