Many clinicians are happy to leave the classification of diseases to others. However, classifications are important. They can have a real effect on how we think about disorders. In practical terms, classifications guide treatment, research and the distribution of funding for both. Ideally classifications should cut nature at its joints. This is well and good when there are clear joints. Classification is much more difficult in situations in which such joints do not exist. The classification of headaches and the classification of epilepsy are examples of that latter situation. Both types of disorders are multifaceted and characterized by uncertain relationships between objective neurobiological changes, patients’ symptoms and the visible manifestations of attacks. These uncertainties mean that there is room for debate. This debate is evident from my Editor’s Choice for the current issue of Seizure, a thorough review of the associations of headaches and epileptic seizures by Carlo Cianchetti, Dario Pruna and Maria Giuseppina Ledda (1), and from the letter by Pasquale Parisi which it provoked (2).
The fact that the classification of headaches associated with epilepsy is difficult is no reason not to try. I have very many patients whose seizures are associated with significant headaches and some for whom seizure-associated headaches are more troublesome than the seizures themselves. These patients are unlikely to be impressed with doctors whose interest is focused entirely on seizures as the “more serious” problem – or on “more typical” manifestations of epileptic seizures than headaches.
 Cianchetti C, Pruna D, Ledda M G. Epileptic Seizures and Headache / Migraine: a Review of Types of Association and Terminology. Seizure 2013:22:679-685.
 Parisi P. New terminology for headache/migraine as the sole ictal epileptic manifestation: the downsides. Seizure 2013:22:748-749.