The rate of headaches then decreased to 61% at 6 months — in contrast with a study by Beckman, et al4 in which medications overuse was found to be the cause of headaches — which Gebhardt and colleagues attributed to likely improvement as a result of immunotherapeutic treatment for MS, including beta interferon and intravenous immunoglobulin therapy.2,3

Identification of migraine at the time of clinically isolated syndrome was predictive of a more symptomatic MS course and was more likely to be associated with the relapsing remitting form of the disease (RRMS) than other forms of headache.1-3 Kister and colleagues also reported a higher incidence of symptoms involving other systems, including visual, psychiatric, and cognitive symptoms and brainstem involvement.1 Scores on scales measuring anxiety, depression, fatigue, and sleepiness were all higher in patients  with migraine, although this did not translate into greater disability.1

Treating Migraine in MS

Because the underlying mechanisms are unknown, specific treatment strategies for migraine and other headache types in MS have yet to be explored, and tend to be treated separately. “MS and migraine are separate entities,” Dr Montieth explained, adding that “MS patients respond well to migraine treatments in most cases.”

Treatment of headache in MS should also take into account the high potential of disease modifying drugs (DMDs), particularly interferons used to treat MS, to induce headache symptoms. The Beckman study4 found that 80% of patients with MS reported headache following the initiation of any kind of MS therapy.

Dr Marrie pointed out that, “MS management involves addressing acute relapses, preventing relapses and disability progression and chronic symptom management. Each of these are components of therapy. Since neurologists often manage headache disorders, this can be incorporated into the care of the person with MS, although headache management may require a different approach — that is, if none of the symptom management therapies can be dually used to manage headache. If headache management is particularly difficult, a neurologist with subspecialty expertise in headache might need to be involved.”

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References

1. Kister I, Caminero AB, Monteith TS, et al. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 2010;11:417-425.

2. Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache in the course of multiple sclerosis: a prospective study. J Neural Transm (Vienna). 2019;126:131-139.

3. Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache at the time of first symptom manifestation of multiple sclerosis: a prospective, longitudinal study. Abstract. Eur Neurol. 2018;80:115-120.

4. Beckmann Y, Türe S. Headache characteristics in multiple sclerosis. Mult Scler Relat Disord 2019;27:112-116.

This article originally appeared on Neurology Advisor