EEG-BM &

Headache
Sub-bag Neurofisiologi/Poli Elektromedik
FK- UGM/RS Sardjito

THE ELECTROENCEPHALOGRAM IN THE EVALUATION OF HEADACHE

The American Academy of Neurology 1994

Headache disorders are clinical

syndromes defined by historical criteria.
The EEG is not included in the diagnostic
criteria of the International Headache
Society for migraine or other major
headache categories.
The majority of headache sufferers do not
have an identifiable structural lesion that
explains their pain.

therefore
An EEG could be considered useful in the
evaluation of headache if abnormalities
were observed that :
(1) separate persons with and without
headache, potentially shedding light on the
underlying pathophysiology of headaches;
(2) define subgroups associated with different
natural histories or responses to therapy; or
(3) effectively identify patients with a definable
structural etiology.

THE EVIDENCES

Electroencephalographic mapping in migraine during the critical and

intercritical periods
Rev Electroencephalogr Neurophysiol Clin. 1987 Sep;17(3):289-99.

Twenty-nine migraineurs underwent spectral

analysis and topographic EEG mapping.
Migraine with a complex aura, posterior-anterior
spreading of slow activities and depression of alpha
activity contralateral to the neurological signs were the
prominent findings.
Migraine with a visual aura had unilateral reduction of
alpha and theta activity.
Common migraine the only abnormality was markedly
reduced alpha activity over one occipital region and
reduction of theta activity in the same location.
Note: In all patients, except one, restudied at least 7 days after an attack, EEG
asymmetries had disappeared

Cont.
Unilateral EEG changes can thus be detected
during attacks of both classic and common
migraine. The posterior-anterior spreading of
slow activities during an induced attack of
classic migraine has temporal and spatial
similarities with the "spreading oligemia.
This suggests that common, as classic, migraine
is associated with unilateral disturbances of
cortical electrogenesis, which might reflect an
underlying metabolic abnormality.

Brain mapping in migraine.

Hughes JR, Robbins LD.
Clin Electroencephalogr. 1990 Jan;21(1):14-24.

The topographic maps of 100 various

types of headache >< 38 normal :
Patients with classic migraine showed 11
markers, but especially three of high
amplitude theta on 0(1) and alpha
on 0(1) and T6,
Patients with other types of headaches
in general did not show useful markers.

EEG in migraine: a review of the literature.

Sand T.Funct Neurol. 1991 Jan-Mar;6(1):7-22.

Results demonstrate that there are no

significant differences between the control group
and the tension-type headache group.
Neither were differences found in migraine
without aura group but in migraine with aura there
was an increase of the theta/alpha ratio in the
temporal posterior and occipital zones.
This ratio could be used as a neurophysiological
indicator in the evolution of the migraine with aura
pathology.

Alpha rhythm power and the effect of photic stimulation in

migraine with brain mapping.
Tsounis S, Varfis G. Clin Electroencephalogr. 1992 Jan;23(1):1-6.

The topographic maps of 50 patients suffering

from migraine with or without aura were
compared to the brain maps of 20 normal
controls and 20 patients with tension-type
headaches.
Only the migraine group showed a significant
decrement of alpha rhythm power, during rest
with eyes closed, at the posterior areas of the
brain, and a significant increment of alpha
power at the same regions during IPS at 20
c/sec.

Clinical neurophysiology studies in headache: a review of data

and pathophysiological hints.
Schoenen J.
Funct Neurol. 1992 May-Jun;7(3):191-204.

In migraine between attacks EMG studies

are normal.
Temporalis exteroceptive silent period
is useful in the differential diagnosis of
headaches and sheds some light on the
pathophysiology of tension-type
headache.

THE ELECTROENCEPHALOGRAM IN THE EVALUATION OF

HEADACHE
The American Academy of Neurology 1994

Prominent photic driving at high flash

frequencies (H-response) in migraine
patients is the most consistently reported
difference between headache patients and
controls.

Quantitative EEG in children with headache.

Valdizan JR, Andreu C, Almarcegui C, Olivito A.
Headache. 1994 Jan;34(1):53-5.

Results demonstrate that there are no significant

differences between the control group and the
tension-type headache group.
Neither were differences found in migraine
without aura group but in migraine with aura there
was an increase of the theta/alpha ratio in the
temporal posterior and occipital zones.
This ratio could be used as a neurophysiological
indicator in the evolution of the migraine with aura
pathology.

Neurophysiological tests and neuroimaging procedures in non-acute

headache: guidelines and recommendations
European Journal of Neurology 2004, 11: 217224

Interictal electroencephalography (EEG) is not

routinely indicated in the diagnostic evaluation of
headache patients.
Interictal EEG is, however, indicated if the
clinical history suggests a possible diagnosis of
epilepsy (differential diagnosis).
Ictal EEG could be useful in certain patients
suffering from hemiplegic and basilar migraine.

Cerebral mapping in subjects suffering from migraine with aura

Dante et al. Cephalalgia Volume 10 Issue 6 Page 279 - December 1990

Cerebralmapping of the spontaneous electroencephalographic activity was

performed in 31 subjects suffering from migraine with aura and the results
were compared with those of a matched control group.
All the patients were examined during the interictal period.
Traditional visual interpretation of EEG records was negative in all exept five
cases (16.1%)
Spectral analysis showed an asymmetry in alpha total power over the
posterior regions in 13 cases (41.9%) and an asymmetry in alpha band peak
frequency in 17 (54.8%).
By means of cerebral mapping and statistical significance probability
demonstrate a significant increase in alpha total power in 13 cases (41.9%)
and a regional increase in delta and theta total power in 20 cases (64.5%).
In comparison with the control group, the migraine patients showed a
widespread increase in slow activity (theta and delta) mostly over the
temporal regions.

Review

In a few controlled and blinded studies, however, slight excess of various EEG
rhythms has been found in migraine patients.
Similar prevalences of interictal EEG abnormalities have generally been found in
patients with classic and common migraine, but the diagnostic classification may not
have been precise enough in some studies.
During visual aura, either slow waves, depression of background activity
amplitude or normal EEG have been reported.
The most definitely abnormal EEGs with unilateral or bilateral delta activity have
been recorded during attacks of hemiplegic migraine, and during attacks of migraine
with disturbed consciousness.
The relationship between migraine and epilepsy has still not been adequately
clarified. The connection seems to exist in several small entities (e.g. migraine-like
headache as an epileptic manifestation, epileptic seizures triggered by epileptic
attacks, and possibly in epilepsies with occipital spike waves), but it is seemingly not
"fundamental".
Newer methods, i.e. EEG frequency analysis and topographic brain mapping, are
promising tools in this field. So far, mostly small studies have been published with
somewhat inconsistent results. A pattern of increased alpha rhythm variability
(and/or asymmetry) in the headache-free phase seems to emerge, however.

Evidence

Migraine

TTH

1987

Posterior-anterior spreading of slow activities

Depression of alpha activity contralateral
Reduction of alpha and theta activity.

1990

High amplitude theta on 0(1) and alpha on

0(1) and T6
Increase in alpha total power
Regional increase in delta and theta total
power
Widespread increase in slow activity (theta
and delta) mostly over the temporal regions.

No marker

1991

Increase of the theta/alpha ratio in the

temporal posterior and occipital zones.

No marker

1992

Decrement of alpha rhythm power, during rest

Increment of alpha power at during IPS

No marker

1992

EMG studies are normal.

Temporalis exteroceptive silent period

1994

Prominent photic driving at high flash

frequencies (H-response)

No abnormality

1994 children

Theta/alpha ratio in the temporal posterior

and occipital zones

No abnormality

Review

Slight excess of various EEG rhythms

slow waves.
Depression of background activity amplitude
Unilateral or bilateral delta activity
Normal EEG

Increased alpha rhythm variability (and/or

asymmetry) in the headache-free phase

THE
RECOMMENDATIONS

 The EEG is not useful in the routine evaluation

of patients with headache.
This does not exclude the use of EEG to
evaluate headache patients with associated
symptoms suggesting a seizure disorder,
such as atypical migrainous aura or episodic
loss of consciousness.
Assuming head-imaging capabilities are readily
available, EEG is not recommended to exclude
a structural cause for headache (option).

CONCLUSION

 Current QEEG methods are not routinely

indicated in the diagnostic evaluation of
headache patients.
Quantitative frequency analysis of EEG
must always be recorded with raw EEG
data and interpreted by a skilled physician
in order to avoid misinterpretation of
technical artifacts, normal state
fluctuations and various physiological
rhythms.