Associations between Headache and Multiple Sclerosis: a prospective study

Abstract

Introduction: The link between headache and multiple sclerosis (MS) has been explored in connection with various demographic and clinical characteristics such as gender, age, disease duration, and disability progression. Additionally, investigations are ongoing to establish a relationship between headache and the clinical course of MS. Literature highlights that headache may serve as an initial symptom of MS, which underscores the importance of paying attention to at-risk groups. Objectives/Aims: To determine the frequency of headache and their associations with demographic and clinical characteristics in multiple sclerosis (MS) patients. Methods: A prospective study was conducted at the Neurology Clinic of the Kaunas Clinics of the Lithuanian University of Health Sciences. A total of 99 patients with MS were surveyed. A targeted questionnaire was used to assess the prevalence and type of headache, with clinical data supplemented from medical histories. Primary headache was diagnosed according to the International Classification of Headache Disorders (ICHD-3) criteria. Results: Primary headache was observed in 48.5% of the participants, with migraine affecting 45.8%, tension-type headache 35.4%, and other types 18.8%. Migraine-type headache had a higher prevalence in women (59.7%). Before the diagnosis of MS, headache affected 31.3% of the participants. Within the headache group, 58.3% of the participants reported a relapse of headache before MS relapses, with 50% of them experiencing migraines, 28.6% tension-type headache, and 21.4% other types of headache. The mean score on the Expanded Disability Status Scale for participants experiencing headache was 4 ± 1.7 points, among those suffering from migraines, the mean score was 3.7 ± 1.6 points. Migraine was the most common headache in relapsing-remitting multiple sclerosis form and progressive form of MS. Headache was present in more than half of MS patients treated with disease-modifying therapy. Conclusion: Headache occurred in slightly less than half of the participants with multiple sclerosis. Among them, migraine-type headache and their prevalence among women were most frequently observed. Participants reported headache less frequently before the diagnosis of MS. No associations were found between types of headache, relapses before MS relapses, severity of disability, duration and clinical course of MS, and the use of disease-modifying therapy.