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Multiple sclerosis and migraine: Links, management and implications

  • Saloua Mrabet
    Correspondence
    Corresponding author at: Blizard Institute, Barts and The London School of Medicine and Dentistry, Centre for Neuroscience, Surgery and Trauma, Queen Mary University of London, 4 Newark St, Whitechapel, London E1 2AT, United Kingdom.
    Affiliations
    Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom

    Royal London Hospital, Department of Neurology, Barts Health NHS Trust, London, United Kingdom
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  • Mohamad Wafa
    Affiliations
    Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom

    Royal London Hospital, Department of Neurology, Barts Health NHS Trust, London, United Kingdom
    Search for articles by this author
  • Gavin Giovannoni
    Affiliations
    Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom

    Royal London Hospital, Department of Neurology, Barts Health NHS Trust, London, United Kingdom
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Published:August 29, 2022DOI:https://doi.org/10.1016/j.msard.2022.104152

      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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