Headache characteristics in multiple sclerosis

Abstract

Objectives: The aims of this study were to study the prevalence and characteristics of headache in patients with multiple sclerosis and to clarify the relationship between headache and multiple sclerosis therapies.

Method: 782 MS patients were consecutively admitted. All patients filled out a detailed headache questionnaire and 754 patients were included.

Results: Of 754 patients, 515 (68%) reported having headache. According to the International Headache Society criteria, we detected 202 (39%) suffering from migraine, 103 (20%) suffering from tension-type headache and 198 (38%) with medication overuse headache. Twelve patients (2%) had unclassified headache. Three hundred and seventy seven patients (73%) were treated with interferon beta, 81 (16%) with fingolimod, 35 (7%) with teriflunamide and 22 (4%) with natalizumab, respectively. One hundred and one (20%) reported that onset of headache occured prior to onset of multiple sclerosis therapies, while 414 (80%) had headaches occured after therapy. A higher incidence of headache was found in patients treated with interferon beta. We found a significant association between migraine and the age of onset of multiple sclerosis therapies. The age of onset of headache was the earliest in the patients with migraine. In migraine patients, the duration of medication use until the headache onset was the shortest when compared to other headache groups. Four hundred and fifty nine patients (89%) have sought help from a physician because of the severity and frequency of headache.

Conclusion: In our study, the prevalence of headache among all multiple sclerosis patients was 68%. The results of this study indicate a possible relationship may exist between headache and multiple sclerosis therapies since 80% of patients described headaches after the onset of treatments. The younger start and the shorter duration of interferon beta use caused the higher incidence of headache, but this correlation was not observed in other drugs. Interestingly, medication overuse headache was far more prevalent in multiple sclerosis patients than in previously reported community populations.