Features of primary forms of headache in multiple sclerosis

Abstract

To study the features of the primary forms of headache in patients with a confirmed diagnosis of multiple sclerosis (MS). A total of 110 patients with MS were examined in the outpatient appointment of a neurologist at the Department of Neurology and Neurosurgery of the «Smolensk State Medical University» in the period from April 1, 2023 to May 31, 2023. A group of 20 people with a diagnosis of primary headache (PH) was selected. At the same time, a control group of 20 people with a diagnosis of PH was selected on the basis of the Center for Industrial Medicine of the Federal State Medical Institution MSU No. 135, Desnogorsk. The analysis of complaints, anamnestic, laboratory data, neurological status and test results on specialized scales was carried out. Migraine was the most frequent type of headache in MS patients (in a ratio of 5.6:1 compared to tension headache) and was observed in 17 (85%) MS patients. Tension headache was diagnosed only in 3 (15%) patients (p=0.002). Headache was significantly more common in the remitting form of MS (p=0.046). Age, total cholesterol level, EDSS level, type of MS disease-modifying therapy were not associated with the risk of developing headache. When comparing the population of patients with MS and PH with the control group on the anxiety and depression scale and the MoCA test, statistically significant differences were obtained (p<0.05). PH were diagnosed in 18.2% of patients with MS, with a much higher prevalence of migraines than tension headache. In addition, female gender and the type of MS are significantly associated with the risk of migraine. Migraine, as a comorbid condition, can aggravate cognitive impairment in patients with MS, characterized by a lower value of the MoCA scale, especially together with the progression of anxiety and depressive disorders. These findings indicate the need for a larger epidemiological study to accurately assess the prevalence of PH in patients with MS in the Smolensk region.