Terminology should be as simple as possible and should express the concepts clearly

We read with interest the letter by Parisi et al. as comment to our review. They discuss our proposal of a preferential use of the term ‘‘Epileptic headache’’ instead of ‘‘Ictal epileptic headache (IEH)’’. In our review it was pointed out, even with references to dictionaries, that the term ‘‘ictal’’ is redundant with respect to the term ‘‘epileptic’’. Moreover, an epileptic headache is necessarily ictal and there are not ‘‘non-ictal’’ epileptic headaches: the ‘‘nonictal’’ are epilepsy-associated headaches, but not epileptic headaches. Therefore ‘‘ictal’’ it is not necessary to differentiate it from ‘‘non-ictal’’, since ‘‘non-ictal’’ is not epileptic. Parisi et al. write: ‘‘We believe that IEH is the term more appropriate and easy to use in order to summarize and define the clinical picture of an event in which headache/migraine is the sole ictal epileptic event not associated with other ictal epileptic signs/ symptoms’’. It is not clear how the term IEH unambiguously can indicate the exclusion of epileptic headaches followed by other clinical manifestations typical of epilepsy. The only way to distinguish the two different conditions in the terminology is to call ‘‘pure’’ or ‘‘isolated epileptic headache’’ when not followed by other typically epileptic manifestations. These are the only epileptic headaches that may pose a diagnostic problem with other types of headache, while the others are clearly identifiable as part of an epileptic event. This distinction was not well considered by Parisi et al., e.g. in their article where they report in Table 1 under the term IEH also cases in which the form is followed by other events, that is 4 out of the 6 cases of ‘‘hemicrania epileptica’’ by Isler and the case of Walker et al. This is in disagreement with the definition they give of IEH. It must be emphasized that, when we speak of ‘‘epileptic headache’’ we mean a condition of a headache (whether migraine or not) with onset coinciding with epileptiform EEG abnormalities (with an epileptic pattern different from the interictal one) corresponding to the duration of the headache, or of the whole seizure when followed by other epileptic manifestations.