91. Headache and Multiple Sclerosis: Is It Disease Related or Treatment Related?

• Published in: Multiple sclerosis and related disorders 2024-12, Vol.92
• Main Authors: Younis, Hossam Hamdy Abdelhady, Shams, Bayan Hesham, Alsubaie, Rasha
• Format: Article
• Language: English
• ISSN: 2211-0348
• DOI: 10.1016/j.msard.2024.106052

Multiple sclerosis (MS) is a chronic neuroinflammatory autoimmune disease affecting the central nervous system (CNS). MS has different phenotypes: relapsing–remitting MS (RRMS) is the most common phenotype and approximately 10–15% of patients might develop primary-progressive MS (PPMS). Clinically isolated syndrome (CIS) is the initial manifestation of MS symptoms prior to a confirmed MS diagnosis. Secondary progressive MS (SPMS) is characterized by the gradual progression of the disease following an initial relapse. The increased incidence of headaches in people with MS(PWMS) raises questions regarding its significance as an important manifestation of the illness and this high prevalence of headache raises the question whether it is really a comorbidity of two independent diseases or whether the headache could be a primary symptom of MS or it's a complications of the disease itself. Clinically and therapeutically, this would be highly relevant, as the presence of headache alone would allow the diagnostic classification as CIS or early MS instead of radiologically isolated syndrome (RIS) and could be helpful to assess disease activity. We have decided to investigate the relationship between MS, its treatment, and headache, trying to find out how common the headache in PWMS and what sort of headache and if its related to the disease process or it is a side effect of disease modifying therapy (DMT). Our study is retrospective cohort analytic study in which we collected the data from our MS patients if they are already diagnosed with any types of headache and we screened the other patients for headache based on The International Classification of Headache Disorders, Third Edition (ICHD-3). Patients with family history of migraine were excluded . A total of 256 patients were included in the study (180 female, 76 male). Of these, 149 met the inclusion criteria, having experienced headaches either before or after MS onset (112 female, 37 male). Among the patients, 49% (74 patients) had migraines, 34% (34 patients) had tension-type headaches, and 16% had headaches classified as not otherwise specified. The highest prevalence of headaches was observed in the interferon group, followed by the cladribine group. Our study showed that headache is common among PWMS especially migraine headache followed by tension headache and most of the patients developed headache after MS onset.