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Peer-reviewedCC BY 4.0Frontiers in Neurology

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

  • Wenchao Cheng1
  • Aochen Shi1
  • Maiqi Du2
  • Yunqing Ma1
  • Yuhan Wang1
  • Hongliang Jiao3
  • Jiefeng Geng3
  • Yajun Lian1
  • Yi Tian3
  • Xiaolei Lian1,3
  1. 1Department of Neurology, The First Affiliated Hospital of Zhengzhou University
  2. 2Department of Neurology, The Second Affiliated Hospital of Zhengzhou University
  3. 3Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University
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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.

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Cite

BibTeXRIS
BibTeX
@article{cheng2026impact,
  title = {{The impact of comorbid headache on surgical outcomes in drug-resistant focal epilepsy}},
  author = {Wenchao Cheng and Aochen Shi and Maiqi Du and Yunqing Ma and Yuhan Wang and Hongliang Jiao and Jiefeng Geng and Yajun Lian and Yi Tian and Xiaolei Lian},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1964217},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1964217/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The impact of comorbid headache on surgical outcomes in drug-resistant focal epilepsy
AU  - Wenchao Cheng
AU  - Aochen Shi
AU  - Maiqi Du
AU  - Yunqing Ma
AU  - Yuhan Wang
AU  - Hongliang Jiao
AU  - Jiefeng Geng
AU  - Yajun Lian
AU  - Yi Tian
AU  - Xiaolei Lian
PY  - 2026
DA  - 2026/10/23
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1964217
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1964217/full
AB  - 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.
SN  - 1664-2295
ER  -