The association between multiple sclerosis and migraine: A meta-analysis

Association between multiple sclerosis lesion location, migraine and tension-type headache: A cross-sectional study

BACKGROUND

An increased prevalence of migraine in people with MS (pwMS) has been documented over the past decade, with one of the leading explanations being the presence of lesions within regions, critical for pain modulation.

OBJECTIVE

To investigate whether lesions within pain areas are associated with primary headaches in pwMS.

METHODS

PwMS fulfilling the 2017 Mc Donald criteria were recruited prospectively in the study. Patients underwent a detailed neurological examination and assesment for primary headache disorders. Brain MRI scans were obtained and assessed. Odd-ratios (ORs) were calculated to examine the potential association of lesions within pain-perceiving brain regions and primary headache disorders.

RESULTS

A total of 96 participants were included in the study. After adjusting for potential confounding factors, PAG lesions were statistically significantly associated with migraine (OR = 4.7; 95 % CI: 1.5 to 14.59; p = 0.008). Similarly, thalamic and cortical lesions were also statistically significantly associated with an increased prevalence of migraine (OR = 7.2; 95 %CI: 1.37 to 37.79; p = 0.02 and OR = 9.1; 95 %CI: 1.53 to 54.72; p = 0.02 respectively) CONCLUSIONS: Lesions within critical brain regions are associated with migraine and are possibly the leading cause of the increased prevalence of migraine in pwMS.

Prevalence pattern and associations of migraine headaches in multiple sclerosis: Insights from a large-scale cross-sectional study

BACKGROUND/AIM

While the comorbidity of migraine and multiple sclerosis (MS) has been documented, large-scale studies examining migraine patterns in MS patients, particularly across diverse age ranges, are scarce. This study aimed to evaluate the prevalence and patterns of migraines in MS patients and compare them with known patterns in the general population from existing literature.

METHODS

This cross-sectional study included 706 MS patients (ages 14-73), spanning pediatric to late-onset MS cases. Descriptive statistics, chi-square tests, and logistic regression were used to analyze the relationships between variables and identify factors influencing the risk of migraines.

RESULTS

Of the 706 patients, 185 (26.2%) were found to have migraines. Among these, 144 patients (77.8%) reported developing migraines after their MS diagnosis. Age and sex did not emerge as significant predictors of migraine prevalence. However, a notable association was observed between MS subtypes and migraine occurrence. Patients with the Relapsing-Remitting MS subtype had higher odds of experiencing migraines (odds ratio = 1.73, 95% CI: 1.03 to 2.89, p = 0.03), as did those with the Primary Progressive MS subtype (odds ratio = 2.48, 95% CI: 1.23 to 4.99, p = 0.01) compared to the Secondary Progressive subtype.

CONCLUSION

Our study highlights distinct patterns of migraine prevalence in MS patients, notably the lack of significant sex- or age-related differences, which contrasts with the established trends in the general population. Additionally, we observed a significant association between MS subtypes, particularly PPMS, and increased migraine risk.

Medical comorbidities in adults newly diagnosed with multiple sclerosis and clinically isolated syndrome: An observational study exploring prevalence, risk factors, and outcomes

BACKGROUND

Comorbidity is common in people with MS (PwMS) and clinically isolated syndrome (CIS), but research exploring factors associated with comorbidity and impacts on health outcomes in newly diagnosed PwMS and CIS is limited. This study aimed to (1) report the prevalence of medical comorbidities in newly diagnosed PwMS and CIS, (2) explore the relationship between comorbidity and demographic factors, (3) examine the relationship between comorbidities and outcomes one year following diagnosis, accounting for baseline outcomes to assess change over time, and (4) explore if these relationships differ with comorbidity treatment.

METHODS

Secondary analysis of data collected from a longitudinal, observational study of adults newly diagnosed with MS or CIS 1 month and 12 months after diagnosis (N = 230). Statistical methods included point biserial, Chi-squared, ANCOVA, and multivariate linear regression.

RESULTS

The most common comorbidities within the first year following diagnosis were mental health (32.9 %), vascular (32 %), neurological (22.5 %), and musculoskeletal (9.1 %). Age and race were associated with hypertension and heart trouble, respectively. After one year, mental health comorbidity was associated with higher fatigue scores, musculoskeletal and neurological comorbidity with higher pain interference, and neurological comorbidity with less exercise, after accounting baseline for fatigue, pain interference and exercise. Those with treated neurological conditions had worse pain interference compared to those with untreated conditions.

CONCLUSIONS

Mental health, neurological, and musculoskeletal comorbidities were common within the first year following diagnosis, and were associated with worse fatigue and pain, and decreased exercise. Future research should explore how early treatment of comorbidities may impact outcomes and disease progression.

Clinical Insights and Radiological Features on Multiple Sclerosis Comorbid with Migraine

Background: Multiple sclerosis (MS) and migraine are neurological diseases, affecting young women. Migraine is the most prevalent type of headache in people with MS (pwMS). Objectives: The aim of this review is to describe the clinical, radiological, and therapeutic features of MS and migraine comorbidity. The clinical section focuses on the characteristics of migraine in pwMS and of MS in co-occurrence with migraine, and on the presence of other possible comorbidities. The radiological section deals with the differential diagnosis of white matter lesions and changes in connectivity patterns on brain magnetic resonanceto investigate a possible link between MS and migraine. The therapeutic section evaluates the effects of MS-disease-modifying therapies on migraine and of prophylactic migraine treatments on MS. Methods: The literature search was conducted using PubMed as an electronic database. The papers that reported relevant clinical, radiological and therapeutic findings were selected. Results: Among 1351 results retrieved, at the end of screening procedures, 34 studies were selected. Migraine can impact the perception of some symptoms and the presence of some comorbidities, particularly relevant in MS. Furthermore, migraine and MS share some radiological features, leading to diagnostic challenges, however identifying some lesion characteristics and changes in the connectivity pathway may be supportive. Medications for migraine and MS should be administered considering both the adverse events and multiple drug interactions. Conclusions: The data emerging from this review illustrate the research efforts aimed at providing valuable insights into accurate diagnosis, effective clinical management, and the definition of targeted treatment schedules that could improve the quality of life for pwMS with migraine.

Migraine in the multiple sclerosis prodrome: a prospective nationwide cohort study in pregnant women

BACKGROUND

People with multiple sclerosis (MS) have an increased risk of migraine. However, little is known about migraine and other headaches during the prodromal phase (before MS symptom onset). Our objective was to study the risk of migraine in women with MS before MS onset.

METHODS

A nationwide, prospective cohort study of women participating in the Norwegian Mother, Father, and Child cohort study 1999-2008. The women reported the occurrence of migraine and other headaches prior to or during pregnancy. We identified women who later developed MS through data linkage with national health registries in 2018. We excluded women with an established MS diagnosis (n = 125) and women who had experienced their first clinical symptom of MS, but not yet received an MS diagnosis (n = 91). The reference group comprised all other women in the cohort (n = 85,292). We used logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).

RESULTS

Two hundred and forty-six women developed MS during follow-up. Of these, 116 women had MS symptom onset after 1-5 years, 92 after 6-10 years, and 38 after 10 years. Migraine was more common among women who developed MS compared to the reference group, 18% vs 11%, aOR 1.6 (1.2-2.3), adjusted for age, smoking, socioeconomic status and overweight. The risk of other headaches was similar for women who developed MS compared to the reference group, 29% vs 27%, aOR 1.1 (0.8-1.4). Migraine was reported by 21 of 116 (18%) women with ≤ 5 years until MS symptom onset (aOR 1.7 [1.1-2.8]) and 19 of 92 (21%) women with 6-10 years until MS symptom onset (aOR 1.9 [1.1-2.8]. Only three of 38 (8%) women with > 10 years until MS symptom onset reported migraine, aOR 0.7 (0.2-2.2).

CONCLUSIONS

Women with MS have increased risk of migraine, but not other headaches, up to a decade before the onset of classical MS symptoms. This supports that migraine can be a symptom of the MS prodrome. Special attention in people with migraine may lead to earlier recognition of MS.

The Challenges in Clinical Diagnosis of Trigeminal Neuralgia: A Review

The lack of established laboratory tests or biomarkers for trigeminal neuralgia (TN) makes diagnosing this relatively rare condition extremely challenging. Trigeminal nerve compression observable on magnetic resonance imaging may indicate TN, but many patients do not have visible lesions or compression. In particular, TN may be confused with migraine, cluster headache, temporomandibular disorder, and other types of headache. An accurate diagnosis is imperative for proper treatment since these conditions do not respond to the same treatment. Many symptoms of these headaches can be vague or overlap, and clinicians depend in large measure on the subjective reports of their patients. Nevertheless, it is imperative to diagnose TN better, which can cause excruciating pain, reduce the quality of life, and even result in disability. It is possible that TN is underestimated.

Headache in Multiple Sclerosis: A Narrative Review

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system characterized by autoimmune-mediated damage to oligodendrocytes and subsequent myelin destruction. Clinical implications: Clinically, the disease presents with many symptoms, often evolving over time. The insidious onset of MS often manifests with non-specific symptoms (prodromal phase), which may precede a clinical diagnosis by several years. Among them, headache is a prominent early indicator, affecting a significant number of MS patients (50-60%). Results: Headache manifests as migraine or tension-type headache with a clear female predilection (female-male ratio 2-3:1). Additionally, some disease-modifying therapies in MS can also induce headache. For instance, teriflunomide, interferons, ponesimod, alemtuzumab and cladribine are associated with an increased incidence of headache. Conclusions: The present review analyzed the literature data on the relationship between headache and MS to provide clinicians with valuable insights for optimized patient management and the therapeutic decision-making process.