Headache in Multiple Sclerosis

Abstract

The aim of this study was to investigate the variables affecting headache occurrence in patients with multiple sclerosis (MS). Seventy-two MS patients with comorbid headaches completed a 28-item questionnaire. This evaluation assessed each patient's demographics, headache description and modifying factors, social history, and impact on quality of life. Our patients reported a wide spectrum of headache presentations, characteristics, and resulting disability. We discuss the patterns in our data in the context of current hypotheses regarding headache and MS causality. In our patients, migraines with aura strongly correlated with MS exacerbations, suggesting that they might be useful as a marker for flare-up onset. Patients' pain descriptions varied based on their headache frequency, history, and relationship to MS progression. Due to the severity of headache in MS patients and resulting impact on their activities of daily living, a thorough analysis of headache presentation is warranted in such patients. Int J MS Care. 2013;15:73-80.P eople with multiple sclerosis (MS) have an increased incidence of headaches, although the comorbidity of headaches and MS is poorly understood. 1 Lifetime prevalence appears to be highly variable, with reports ranging from 4% to 58%. [2][3][4][5][6][7] Despite the inconsistency of prevalence reporting, there is clinical value in the identification of headache incidence in MS patients. 2,8,9 Evidence suggests that headaches may vary based on MS form and lesion location, and MS patients with migraines have a more symptomatic clinical course of the disease. 8 In addition, screening patients with MS for headaches has treatment implications. Several medications used to treat MS have been shown to exacerbate headaches, leading to a decreased quality of life and possible treatment nonadherence. 8 Owing to the highly variable presentation of headaches in patients with MS, much remains to be elucidated about the variables affecting headache development. We analyzed a number of factors in relation to headache incidence in a sample of our patients with MS, focusing on headache history, pain description, modifying factors, social history, relation to disease progression, and impact on quality of life.

Pathophysiological Bases of Comorbidity in Migraine

“…The relationship between migraine and the disease activity was investigated by a study of Tabby et al ( 2013 ), who showed that MS patients with migraine presented more relapses than patients without migraine and that 85% of patients whose attacks were often or always of severe intensity reported a headache worsening during MS exacerbations. Furthermore, Kister et al ( 2010 ) observed that migraine in MS patients was significantly associated with a more symptomatic course of the disease, but not with disability or T2 lesion burden on brain magnetic resonance imaging (MRI).…”

Headache in the first manifestation of Multiple Sclerosis – Prospective, multicenter study

“…These results are comparable with other studies. In a work of Tabby, Majeed, Youngman, & Wilcox (), throbbing headaches were found in 52.9% patients as the most frequent form in 72 MS patients with headaches. D'Amico et al.…”

Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review

“…MS patients who associate migraine headaches seem to have typical migraine characteristics but with a more important severity regarding the intensity of pain and a high frequency of headache attacks [13]. The most frequent headache triggers described in the studies were fatigue and stress [8]. It has also been shown that stress precipitates MS exacerbations.…”

“…There have been rare instances of cluster-type headaches reported among these patients. The infrequency of cluster-type headaches in this context could be attributed to their low prevalence in the general population [8,9]. Migraines associated with multiple sclerosis represent the subject of many studies.…”