Ictal headaches are headaches associated with seizure activity. They may occur either before (pre-ictal) or after (post-ictal) a seizure, and in rare circumstances during a seizure. Many cases of ictal headache may be misdiagnosed as migraine with aura, or even cluster headache. However, while these conditions usually involve just one side of the head (are unilateral), an ictal headache may be centrally situated or cover the entirety of the head.

Severity of ictal headaches can vary from a slight pressure or “cloud” to an intensity far beyond migraine. Some have called it a “suicide headache” in the worst instances. Temporary blindness may also occur in some cases.

Ictal headaches can often be controlled with anticonvulsants.

Symptoms besides headache may be either present or absent, and may include unusual thoughts or experiences. In these cases it is especially important to obtain a correct diagnosis. Many people with these experiences are accidentally diagnosed with conditions such as psychosis or schizophrenia and given antipsychotic medications, which may actually increase seizure activity.

An EEG is recommended to detect other signs of epilepsy. Even when an EEG does not prove determinative, anticonvulsants may be a first line of treatment if these symptoms are present with headache.