Highlights
- •Migraine is a frequent and disabling comorbid condition in pwMS.
- •Clinicians need to distinguish between an MS relapse and a migraine aura.
- •Inflammatory brainstem lesions in pwMS are more likely associated with migraine.
- •Effect of CGRP inhibitors in pwMS under DMTs needs confirmation.
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease leading to multifocal neuronal
demyelination and axonal damage in the central nervous system (CNS). MS symptoms vary
widely but typically do not include headaches. A large spectrum of headaches manifestations
was reported as comorbidities in MS and results in additional disability. Migraine,
tension-type headache and cluster headache are the most frequently reported primary
headache syndromes in patients with MS (pwMS). Secondary causes of headache should
be excluded (cerebral vein thrombosis, CNS or systemic infection, cervical and/or
cranial trauma, headaches associated with psychiatric disorders, medication overuse
headache, etc.) in this particular population. A careful medical history and general
and neurological examinations and sometimes further investigations may be needed to
rule out secondary headache syndromes. In pwMS, the headache could be an adverse effect
of the disease-modifying therapies or a complication of pain medication overuse prescribed
to relieve other causes of pain related to MS (neuropathic pain, mechanical pain,
pain associated with spasticity, etc.). Migraine-type headache occurs in pwMS more
frequently than in the general population. It can precede the disease onset, be associated
with relapses, or appear during the MS course. A predominance of brainstem inflammatory
lesions is described on magnetic resonance imaging (MRI) in MS patients with migraine.
The relationship between both conditions remains unclear. Migraine and MS occur in
the same demographic groups with similar background factors, including gender, hormonal
status, and psychological features (anxiety, depression, stress). An early diagnosis
and adequate treatment of migraine in MS patients are important to improve their quality
of life. In this review, we focus on the relationship between MS and Migraine, discuss
the differential diagnoses of migraine in pwMS, and describe its management in this
particular context.
Keywords
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Article info
Publication history
Published online: August 29, 2022
Accepted:
August 28,
2022
Received in revised form:
August 22,
2022
Received:
June 5,
2022
Identification
Copyright
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