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Headache and Its Management in Patients With Multiple Sclerosis

  • Headache (JR Couch, Section Editor)
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Abstract

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).

Recent findings

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.

Summary

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.

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Abbreviations

H/As:

Headaches

EM:

Episodic migraine

CM:

Chronic migraine

CDH:

Chronic daily headaches

ICHD:

International Classification of Headache Disorders

IHS:

International Headache Society

SLE:

Systemic lupus erythematosus

QOL:

Quality of life

HIT-6:

Headache Impact Test

MIDAS:

Migraine Disability Assessment

DMT:

Disease-modifying therapy

IFN-B:

Interferon beta

PRES:

Posterior reversible encephalopathy syndrome

CADASIL:

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

CGRP:

Calcitonin gene-related peptide

CNSV:

Central nervous system vasculitis

NSAIDs:

Non-steroidal anti-inflammatory drugs

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Authors and Affiliations

  1. Department of Neurology/Rehabilitation, Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA

    Farhat Husain MD & Meheroz Rabadi MD

  2. Oklahoma Medical Research Foundation, MS Center of Excellence, Oklahoma City, USA

    Gabriel Pardo MD

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  1. Farhat Husain MD
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Correspondence to Farhat Husain MD.

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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.

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Husain, F., Pardo, G. & Rabadi, M. Headache and Its Management in Patients With Multiple Sclerosis. Curr Treat Options Neurol 20, 10 (2018). https://doi.org/10.1007/s11940-018-0495-4

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