In two recent studies, researchers suggest that new or worsening migraine, which doesn’t respond to treatment, should be considered a possible symptom of multiple sclerosis (MS).
Scientists in Rostock, Germany, conducted a study investigating headache symptoms in patients already diagnosed with MS. Their aim was to detect the prevalence of headache and subtypes of headache, such as migraine, cluster, and tension-type headache, in an unselected group of MS patients, and to isolate the possible factors causing those headaches.
The group comprised 125 women and 55 men, and included patients diagnosed with relapsing-remitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndrome. Patients were chosen, regardless of gender, age, or disability.
Do MS patients experience headache or migraine?
Ninety-eight MS patients reported experiencing headache during the previous four weeks, while 82 MS patients said they had not experienced any headache during this period. In the general population, the prevalence of headache is estimated to be 47 percent based on a large meta-analysis of 107 studies (Stovner, 2007). Based on this statistic and the present study, it would appear that MS patients are more likely to experience headache than healthy controls.
Using diagnostic criteria established by the International Headache Society (IHS), researchers in the study detected 16 MS patients suffering from migraine (2 had migraine with aura and 14 had migraine without aura), 23 patients with tension-type headache and none with cluster headache, while the headache of 59 MS patients went unclassified.
Migraine is a pulsating, often one-sided headache with a duration of four to 72 hours, with a prevalence of 10 percent in the normal population. Tension-type headache is characterized as a continual nagging-pressing pain. Cluster headaches are much more rare, and are described as a sharp paroxysmal unilateral pain of severe intensity, often associated with eye pain.
Who is more likely to experience headache among MS patients?
When comparing MS patients with and without headache, researchers identified significant differences in socio-demographic (age, gender) and clinical data (MS course, physical functioning, pain, and social functioning). MS patients with headache were significantly younger, more likely to be female, and less disabled, but they experienced more pain. Patients who reported more bodily pain were also more likely to suffer from tension-type headache.
The researchers in Germany concluded that headache is a relevant symptom in MS patients, one that occurs more frequently in early stages of the disease, especially in women.
Can migraine be an early symptom of MS?
A recent case report discusses a 33-year-old woman with worsening migraine as an initial symptom of MS without any neurological signs (Lin. 2013). With a history of severe throbbing headaches, she already had a diagnosis of migraine without aura. She then began to experience more severe headaches, which didn’t respond to treatment.
She then experienced an episode of blurred vision in both eyes and right facial numbness that resolved quickly after 24 hours. Magnetic resonance imaging (MRI) of the brain revealed both gadolinium-enhancing lesions and non-enhancing lesions. She was diagnosed with MS, but declined to begin disease-modifying therapy.
Two months later, she developed numbness in her legs, an unsteady gait, and bladder and bowel dysfunction. A worsening of her migraine was noted again. Follow-up MRIs revealed more lesions, including new gadolinium-enhancing lesions, and visual evoked potentials (VEP) revealed damage to the optic nerves. After a five-day course of IV Solumedrol therapy to treat the MS relapse, her physical symptoms resolved, and her headache improved significantly.
Challenge of diagnosing MS with symptomatic migraine
Study authors stress that acute worsening migraine without neurological signs as the first episode of MS may lead to diagnostic difficulties. Migraine symptoms and changes in headache patterns can be discounted as a recurrent event and ignored by clinicians.
However, this study suggests it is important to consider the possibility of MS in patients with worsening migraine and to follow up with these patients regularly. Failure to recognize MS may lead to inappropriate treatment and worse prognosis. Early diagnosis is essential to improving a patient’s clinical outcome and quality of life.
In conclusion, headache in MS patients is a relevant symptom, especially in early stages of the disease. If you experience increased headaches, do not hesitate to contact your neurologist. Your headache could be a symptom of an MS relapse and may respond to steroid treatment when migraine treatments fail.
Lin GY, Wang CW, Chiang TT, Peng GS, Yang FC. Multiple sclerosis presenting initially with a worsening of migraine symptoms. J Headache Pain. 2013 Aug 9;14(1):70. doi: 10.1186/1129-2377-14-70. http://www.ncbi.nlm.nih.gov/pubmed/23937696
Möhrke J, Kropp P, Zettl UK. Headaches in multiple sclerosis patients might imply an inflammatorial process. PLoS One. 2013 Aug 5;8(8):e69570. doi: 10.1371/journal.pone.0069570. Print 2013. http://www.ncbi.nlm.nih.gov/pubmed/23940524
Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210. http://www.ncbi.nlm.nih.gov/pubmed/17381554
Ergün U, Ozer G, Sekercan S, et al. Headaches in the different phases of relapsing-remitting multiple sclerosis: a tendency for stabbing headaches during relapses. Neurologist. 2009 Jul;15(4):212-6. doi: 10.1097/NRL.0b013e3181906fc9. http://www.ncbi.nlm.nih.gov/pubmed/19590381
Klein M, Woehrl B, Zeller G, Straube A. Stabbing headache as a sign of relapses in multiple sclerosis. Headache. 2013 Jul;53(7):1159-61. doi: 10.1111/head.12138. Epub 2013 Jun 28.
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