Stabbing Headache as a Sign of Relapses in Multiple Sclerosis

Klein, Matthias; Woehrl, Bianca; Zeller, Grete; Straube, Andreas

doi:10.1111/head.12138

Cited by 19 publications

(10 citation statements)

References 9 publications

(21 reference statements)

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“…[17][18][19] Klein and colleagues reported stabbing headaches during an MS patient's relapse without any new T2-weighted lesions. 20 However, during headaches, CSF analysis showed inflammatory pleocytosis that originated from meningeal inflammation. 20 Mariotti et al reported a pediatric patient with MS who suffered from a migrainelike headache at the onset of the disease.…”

Section: Discussionmentioning

confidence: 99%

Migraine Headache as a Presenting Feature of Multiple Sclerosis: A Case Report

Rabiei

Cheraghi

Ramezani

et al. 2021

Int Clin Neurosci J

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Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system. Symptoms of MS vary widely because of different grades of sensory, motor, and cognitive dysfunctions. Although headache as the initial symptom of MS is rare, it is a common comorbidity that affects most patients. However, it is unclear that the headache manifestation in newly diagnosed people with MS should be considered as an MS attack or merely a comorbid condition. We report the case of a 31-year-old woman with newly diagnosed MS who presented with exacerbation of headache episodes without any abnormal neurological exam findings. The headaches did not respond to nonsteroidal anti-inflammatory drugs and triptans. After administration of methylprednisolone, the headaches were significantly improved, and during 3 months of follow-up receiving glatiramer acetate, no episode of headache has occurred. This case demonstrates the possible relationship between migraine and MS in newly diagnosed patients. New-onset headaches, a change in the pattern of previous episodes, and inadequate clinical drug response to headache treatment should all be taken seriously and warrant further investigation. Thereby, early diagnosis and proper treatment for patients with MS could improve their quality of life.

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Section: Discussionmentioning

confidence: 99%

Migraine Headache as a Presenting Feature of Multiple Sclerosis: A Case Report

Rabiei

Cheraghi

Ramezani

et al. 2021

Int Clin Neurosci J

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“…Nevertheless, in daily clinical routine, it is difficult to treat patients with RIS. The presence of cases with headache as the only symptom of MS and completely remission under GCS therapy [19] is a strong argument for treatment. A practical solution could be treating RIS patients with the presence of oligoclonal bands and unclassified headache with steroids, after exclusion of contraindication and other causes of secondary headache.…”

Section: Discussionmentioning

confidence: 99%

Headache at the Time of First Symptom Manifestation of Multiple Sclerosis: A Prospective, Longitudinal Study

et al. 2018

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Aims: Headaches have not been considered a typical symptom of multiple sclerosis (MS), although since 2000, almost every study showed high prevalence. We screened 50 MS patients at the time of first occurrence of neurological symptoms and found the highest prevalence of headache in MS that was ever recorded (78%). Postmortem histological analyses of MS patients’ brains revealed lymphoid follicle-like structures in the cerebral meninges and a pathophysiological link between headache, and high inflammatory activity especially in the initial phase of MS could be suspected. The aim of this study was to get insights into the persistence of headache in the further progress of the disease. Methods: In a prospective, multicenter study, 50 MS patients at the time of first symptom manifestation were screened for the presence of headache within the last 4 weeks and again 6 months later with help of the Rostock Headache Questionnaire (Rokoko) as well as using the evaluation of case history and clinical-neurological investigation. Results: We found a decrease of headache prevalence after 6 months from 78 to 61% (p = 0.01). We could also show a decrease of headache frequency, measured by days with headache in the last 4 weeks (9.5 vs. 5.9, p = 0.001). Migraine or probable migraine was the most frequent headache. In both investigations, the most frequent headache was recurrent pain with pulsating and throbbing character that lasted between 4 and 72 h. Conclusion: Headaches should be taken seriously as an important symptom in early MS. The decrease of headache 6 months after first symptom manifestation of MS could be a result of the immunomodulatory therapy. Young patients in whom migraine-like headaches occur should obligatory undergo an MRI of the head, and in the case of abnormal findings differential diagnosis should be initiated. This could reduce latency until final diagnosis of MS and enable early treatment.

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“…However, these patients had primary stabbing headache according to ICHD‐2 criteria with a wide variety of autoimmune disorders that could potentially affect the central and peripheral nervous systems. Two recent studies have demonstrated associations of stabbing headache in the context of a relapse of multiple sclerosis . One group proposed that subpial grey matter and meningeal inflammation may sensitize trigeminal sensory fibers that lead to spontaneous activity of trigeminal branches .…”

Section: Symptomatic Stabbing Headachementioning

confidence: 99%

“…Two recent studies have demonstrated associations of stabbing headache in the context of a relapse of multiple sclerosis . One group proposed that subpial grey matter and meningeal inflammation may sensitize trigeminal sensory fibers that lead to spontaneous activity of trigeminal branches . It is not clear if a similar mechanism on a smaller scale would be relevant to the occurrence of primary stabbing headache in the general population.…”

Section: Symptomatic Stabbing Headachementioning

confidence: 99%