Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system. Symptoms of MS vary widely because of different grades of sensory, motor, and cognitive dysfunctions. Although headache as the initial symptom of MS is rare, it is a common comorbidity that affects most patients. However, it is unclear that the headache manifestation in newly diagnosed people with MS should be considered as an MS attack or merely a comorbid condition. We report the case of a 31-year-old woman with newly diagnosed MS who presented with exacerbation of headache episodes without any abnormal neurological exam findings. The headaches did not respond to nonsteroidal anti-inflammatory drugs and triptans. After administration of methylprednisolone, the headaches were significantly improved, and during 3 months of follow-up receiving glatiramer acetate, no episode of headache has occurred. This case demonstrates the possible relationship between migraine and MS in newly diagnosed patients. New-onset headaches, a change in the pattern of previous episodes, and inadequate clinical drug response to headache treatment should all be taken seriously and warrant further investigation. Thereby, early diagnosis and proper treatment for patients with MS could improve their quality of life.
Highlights
Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system (CNS).[1]
We report a case with status migrainosus as an MS attack with new T2 lesions and provide a comprehensive review of MS attacks presenting migraine headaches
We report a case that showed the association between the onset of status migrainosus with progressive T2-fluid-attenuated inversion recovery (FLAIR) and new gadolinium-enhancing demyelinating lesions on the initial and subsequent Multiple Sclerosis imaging (MRI)
Summary
Multiple sclerosis (MS) is a chronic inflammatory disease, causing neuronal demyelination and axonal damage in the central nervous system (CNS).[1]. Case Presentation Case Summary A 31-year-old woman was referred for evaluation after three days of left-sided slowly progressive blurred vision, with periocular pain aggravated by eye movements. She had a history of migraine without aura once every two months since adolescence. After 4 months, she experienced moderate to severe right temporoparietal throbbing headaches associated with blurred vision, sensitivity to light, sound, and nausea. Her headache was more severe than previous ones, and she found neither nonsteroidal anti-inflammatory drugs nor triptans to be effective anymore. On the three months follow-up, she mentioned complete recovery of migraine headaches
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