Farhat Husain1, Gabriel Pardo2, Meheroz Rabadi3. 1. Department of Neurology/Rehabilitation, Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA. Farhat.husain@va.gov. 2. Oklahoma Medical Research Foundation, MS Center of Excellence, Oklahoma City, USA. 3. Department of Neurology/Rehabilitation, Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.
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. 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.
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. 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 astriptans. 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.
Authors: Stewart Tepper; Messoud Ashina; Uwe Reuter; Jan L Brandes; David Doležil; Stephen Silberstein; Paul Winner; Dean Leonardi; Daniel Mikol; Robert Lenz Journal: Lancet Neurol Date: 2017-04-28 Impact factor: 44.182
Authors: Christian Lampl; Hallie Thomas; Cristina Tassorelli; Zaza Katsarava; Jose Miguel Laínez; Michel Lantéri-Minet; Daiva Rastenyte; Elena Ruiz de la Torre; Lars Jacob Stovner; Colette Andrée; Timothy J Steiner Journal: J Headache Pain Date: 2016-06-01 Impact factor: 7.277
Authors: Alasdair J Coles; D Alastair S Compston; Krzysztof W Selmaj; Stephen L Lake; Susan Moran; David H Margolin; Kim Norris; P K Tandon Journal: N Engl J Med Date: 2008-10-23 Impact factor: 91.245