Neurológia pre prax 6/2023

Migraine and multiple sclerosis

The association of headaches and multiple sclerosis (MS) has been found in the last years in more studies. Most of them are of migrainous type. The prevalence of migraine in MS patients is significantly higher (46%) than in general population (10–15%). This association is considered in clinical practice usually as a comorbidity of two independent diseases. Some facts however indicate, that headaches, especially of migrainous type, could be also the symptom of MS. Then they would belong to the secondary headaches. The headache occurs with increased frequency especially in the initial stage of MS. A prospective multicenter study has revealed the occurrence of headache in 78% of patients with clinically isolated syndrome (CIS) or early MS. Most often patients suffered from throbbing and pulsating headaches of migrainous type. The headache is also in half of cases the cause of brain MRI (magnetic resonance imaging) performance in radiologically isolated syndrome(RIS). This high frequency raises the question, whether it is really a comorbidity of two independent diseases or whether the headache could be also a primary syndrome of MS. Clinically and therapeutically this is very important, as presence of headache alone would allow the classification as CIS instead of RIS and to treat the patients accordingly with immunomodulatory therapy. In addition nowadays the question is being discussed, whether to treat already in the stage of RIS.

Keywords: headache, migraine, multiple sclerosis, comorbidity, disease modifying drugs, clinically isolated syndrome, radiologically isolated syndrome