Headache in Multiple Sclerosis From a Different Perspective: A Prospective Study

Abstract

Objective: It is known that patients with multiple sclerosis have a high incidence of headache. Although there is increasing evidence to suggest that periaqueductal gray matter (PAG) plays a role in the pathophysiology of migraine headache, it is not known whether the type of headache may be a predictor of a MS relapse. Patients and Methods: The study enrolled 100 patients (68 females, 32 males) with clinically confirmed MS diagnosis established by McDonald diagnostic criteria. The type and duration of MS, MRI localization of lesions and cognitive status were recorded for all patients. Patients were questioned whether they experience headache during MS attacks. Results: Sixty-eight percent of the patients had headache and 32% of the patients were free of headache. Of the patients with headache, 16% had tension –type headache (TTH), 14% had migraine, 11% had primary stabbing headache (PSH), 8% had TTH+ migraine, 6% had PSH+ migraine, 6% had medication overuse headache , 2% had medication overuse headache + migraine, 2% had paroxysmal hemicrania, 1% had cervicogenic headache, 1% had chronic TTH, and 1% had unclassified headache. There was a statistically significant relationship between the presence of headache and MS relapse (p<0.001). We found a statistically significant relationship between the type of headache and the localization of plaques in all MS patients in a statistical analysis using chi-square test, (p<0.001). Conclusion: Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing headache and MS relapses merits further investigation.