Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course

Abstract

The objectives of this study were: (1) to assess relative frequency of migraine in multiple sclerosis (MS) patients using the validated self-administered diagnostic questionnaire, and to compare the migraine rates in MS outpatients to age- and gender-matched historical population controls; (2) to compare clinical and radiographic characteristics in MS patients with migraine and headache-free MS patients. We conducted a cross-sectional study to assess the demographic profiles, headache features and clinical characteristics of MS patients attending a MS clinic using a questionnaire based on the American Migraine Prevalence and Prevention (AMPP) study. We compared the relative frequency of migraine in MS clinic patients and AMPP cohort. We also compared clinical and radiographic features in MS patients with migraine to an MS control group without headache. Among 204 MS patients, the relative frequency of migraine was threefold higher than in population controls both for women [55.7 vs. 17.1%; prevalence ratio (PR) = 3.26, p < 0.001] and men (18.4 vs. 5.6%; PR = 3.29, p < 0.001). In a series of logistic regression models that controlled for age, gender, disease duration, β-interferon use, and depression, migraine in MS patients was significantly associated (p < 0.01) with trigeminal and occipital neuralgia, facial pain, Lhermitte’s sign, temporomandibular joint pain, non-headache pain and a past history of depression. Migraine status was not significantly associated with disability on patient-derived disability steps scale or T2 lesion burden on brain MRI. Migraine is three-times more common in MS clinic patients than in general population. MS–migraine group was more symptomatic than the MS–no headache group.

Headache in Multiple Sclerosis

“…One observation that supports this hypothesis is that both MS activity and migraine frequency were reduced in pregnancy. 8 Our findings are consistent with the common observation that headaches worsen during menstruation and tend to decline during pregnancy. Twenty-seven percent of our sample indicated headache exacerbations during menses.…”

“…8 These findings may be attributed to the observation that debilitating headaches, such as migraines, trigger more severe inflammation in the brain, prompting a positive relationship between headache severity and the degree of disability. Another explanation is that increased frequency of severe headaches induces a central sensitization and a lowering of pain threshold for each degree of lesion-induced disability.…”

“…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.…”

“…[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.…”