Headache and Its Management in Patients With Multiple Sclerosis
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Purpose of review
The purpose of this review was to discuss the prevalence, impact, pathophysiology, and treatment of headaches (H/As) in patients with multiple sclerosis (MS).
Headaches and multiple sclerosis are more common in women than in men with the ratio of female to male being 3:1. It is not entirely clear if there is a correlation or an incidental comorbidity of two neurological conditions. A review of the literature shows a variable prevalence of H/As in MS patients. Using the International Classification of Headache Disorders (ICHD) criteria, the primary type of H/As, especially migraine, is the most common type seen in patients with MS. One of the theories of the pathophysiologic mechanisms of migraine in MS patients is inflammation leading to demyelinating lesions in the pain-producing centers in the midbrain. Secondary H/As due to MS medications such as interferons are also frequently present.
H/As can be a cause for significant comorbidity in patients with MS. The treatment of H/As in patients with MS should be addressed in the same fashion as in the non-MS population, which is a combination of pharmacological and non-pharmacological methods. Preventive medicines for the H/As should be carefully selected because of their side effect profiles. Acute attacks of migraines can be treated with medications such as triptans. Patients with MS who have migraine H/As should be educated about the phenomenon of overuse H/As, keeping headache journals, avoiding stress, and monitoring sleeping habits. The presence of depression in patients with MS and migraine affects quality of life (QOL) and should also be addressed for better outcomes.
KeywordsPrevalence Pathogenesis Multiple sclerosis Headaches Mimics Treatment
Chronic daily headaches
International Classification of Headache Disorders
International Headache Society
Systemic lupus erythematosus
Quality of life
Headache Impact Test
Migraine Disability Assessment
Posterior reversible encephalopathy syndrome
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Calcitonin gene-related peptide
Central nervous system vasculitis
Non-steroidal anti-inflammatory drugs
Compliance with Ethical Standards
Conflict of Interest
Farhat Husain and Meheroz Rabadi declare no conflict of interest.
Gabriel Pardo is a consultant for Bayer and is a consultant and on speaker’s bureau for Biogen, Genentech, Genzyme, Novartis, Serono, and Teva.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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