Work

The impact of comorbid headache on surgical outcomes in drug-resistant focal epilepsy

Year: 2026

Type: article

Abstract: Background Headache is a common comorbidity of epilepsy and is closely associated with the poor prognosis of epilepsy. Resection surgery of the epileptogenic focus is an effective treatment method for drug-resistant focal epilepsy (DRFE). However, the relationship between headache and surgical outcomes remains unclear. This study aimed to investigate the impact of comorbid headache and its characteristics on short-term surgical outcomes in DRFE. Methods DRFE patients undergoing resection surgery were consecutively enrolled and followed up for at least one year after surgery. Seizure-free rate within 1 year after surgery was compared between the headache and non-headache groups. Subgroup analysis was performed within the headache group to compare headache characteristics between patients who were seizure-free and those who experienced seizures within 1 year after surgery. Results A total of 103 DRFE patients were enrolled, among whom 46 (44.7%) had comorbid headache. Of the 46 patients, 23 experienced unilateral headache, and in 22 of these 23 patients (22/23, 95.7%), the headache side was ipsilateral to the epileptogenic focus. The difference in the seizure-free rate within 1 year after surgery between the headache and non-headache groups was not statistically significant (78.3% vs. 73.7%, p = 0.590). Among DRFE patients with comorbid headache, compared with the seizure within 1 year after surgery group, unilateral headache was significantly more frequent (58.3% vs. 20.0%, p = 0.032), and the mean preoperative visual analogue scale (VAS) score was significantly lower (5.50 ± 2.171 vs. 7.60 ± 1.578, p = 0.007) in the seizure-free within 1 year after surgery group. Multivariate binary logistic regression analysis demonstrated that unilateral headache was independently associated with higher odds of seizure-free within 1 year after surgery (OR = 1.854, 95% CI 1.112–3.092, p = 0.018), whereas the preoperative VAS score was independently associated with lower odds of seizure-free within 1 year after surgery (OR = 0.136, 95% CI 0.020–0.923, p = 0.041). Conclusion Comorbid headache does not significantly affect short-term surgical outcomes in DRFE patients. However, for DRFE patients with comorbid headache, unilateral headache or a lower preoperative VAS score may serve as potential clinical indicators for favorable short-term surgical outcomes.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1964217