Headache in Multiple Sclerosis - Pharmacological Aspects

Abstract

: For decades, headache was not considered a typical symptom of multiple sclerosis (MS) and was construed as a "red flag" for important differential diagnoses such as cerebral vasculitis. Meanwhile, several studies have demonstrated an increased prevalence of headache in MS compared to the general population. This is due to the heterogeneity of headache genesis with frequent occurrence of both primary and secondary headaches in MS. On the one hand, MS and migraine are often comorbid. On the other hand, secondary headaches occur frequently, especially in the course of MS relapses. These are often migraine-like headaches caused by inflammation, which can improve as a result of MS-specific therapy. Headaches are particularly common in the early stages of chronic inflammatory CNS disease, where inflammatory activity is greatest. In addition, headache can also occur as a side effect of disease-modifying drugs (DMDs). Headache can occur with most DMDs and is most frequently described with interferon-beta therapy. The aim of this work is to present the prevalence of headache and describe the heterogeneity of possible causes of headache in MS. In addition, important therapeutic aspects in the treatment of MS patients in general will be presented as well as different approaches to the treatment of headache in MS depending on the etiological classification.

Headache in Multiple Sclerosis: A Narrative Review

“…Headache is still considered a "red flag" in the diagnostic process, indicating potential alternative diagnoses to MS [54]. In their multicenter study, Solomon et al assessed 110 patients misdiagnosed with MS and found that migraine alone or in combination with additional diagnoses was the most common alternative diagnosis (22% of cases).…”

Multiple Sclerosis and Sodium Toxicity: Controversy and Future Directions for Low-Salt Interventions

“…The prevalence of primary headache among MS patients is higher than in the general population, according to a systematic review and meta-analysis of global studies [76]. Migraine headaches in particular are often comorbid with MS [77], and evidence suggests that sodium chloride intake is associated with migraine headache pain [78]. Sodium chloride intake is also associated with posterior lumbar subcutaneous edema in nonspecific low back pain [79].…”