Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jan;11(1):e01830.
doi: 10.1002/brb3.1830. Epub 2020 Dec 8.

The epidemiology of primary headaches in patients with multiple sclerosis

Long Wang  1 , Juan Zhang  1 , Zi-Ru Deng  1 , Mei-Dan Zu  1 , Yu Wang  1
Affiliations
Meta-Analysis

The epidemiology of primary headaches in patients with multiple sclerosis

Long Wang et al. Brain Behav. 2021 Jan.

Abstract

Objective: Recent studies have shown a pathophysiologic link between headache and multiple sclerosis (MS), but the prevalence of primary headaches among patients with MS differs substantially across studies. This meta-analysis aimed to comprehensively gather available evidence to estimate the prevalence of primary headaches among patients with MS.

Method: We systematically searched the electronic databases including PubMed, Embase, and Scopus for cohort, case-control, cross-sectional studies that measured the prevalence of headache among patients with MS. Two reviewers independently screened titles and abstracts to identify the eligible studies and the full texts of the included studies were reviewed. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included literatures. We then conducted a meta-analysis using Stata Software 15.0 to calculate the pooled prevalence of headaches among patients with MS and assess the source of heterogeneity.

Results: We identified 16 eligible studies covering a total of 3,560 patients with MS. The pooled estimated prevalence of primary headaches among patients with MS was 56%. The statistical heterogeneity was moderate with I2 of 82.1% (p < .001). Both a visual inspection of the funnel plot and Egger' regression tests revealed no significant publication bias (p = .44). The pooled estimated prevalence of migraine (55%) was higher in comparison with that of tension-type headache (20%). The prevalence of migraine subtype was 16% and 10% for migraine without aura and migraine with aura, respectively. The pooled prevalence of primary headache in case-control group (57%) was approximately in line with the cross-sectional group (56%).

Conclusion: The overall prevalence of primary headaches among patients with MS was considerably high. Clinical screening of headache among patients with MS will be helpful to formulate an individualized treatment plans and alleviate the physical and mental impact of the disease.

Keywords: headache; meta-analysis; multiple sclerosis; prevalence; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIGURE 1
FIGURE 1
Flowchart of study identification for meta‐analysis
FIGURE 2
FIGURE 2
Forest plot for prevalence of primary headaches in patients with MS
FIGURE 3
FIGURE 3
Forest plot for subgroup analysis (types of headache)
FIGURE 4
FIGURE 4
Forest plot for subgroup analysis (study design)
FIGURE 5
FIGURE 5
Forest plot for subgroup analysis (regional distribution)
FIGURE 6
FIGURE 6
Funnel plot for prevalence of primary headache in patients with MS
See this image and copyright information in PMC

References

    1. Applebee, A. (2012). The clinical overlap of multiple sclerosis and headache. Headache, 52, 111–116. - PubMed
    1. Artero‐Morales, M. , González‐Rodríguez, S. , & Ferrer‐Montiel, A. (2018). TRP channels as potential as targets for sex‐related differences in migraine pain. Frontiers in Molecular Biosciences, 5, 73. - PMC - PubMed
    1. Beckmann, Y. , & Türe, S. (2019). Headache characteristics in multiple sclerosis. Multiple Sclerosis and Related Disorders, 27, 112–116. - PubMed
    1. Benito‐León, J. , & Bermejo‐Pareja, F. (2010). Is the epidemiology of multiple sclerosis changing? Revue Neurologique, 51, 385–386. - PubMed
    1. Bourgeais‐Rambur, L. , Beynac, L. , & Villanueva, L. (2019). Brain network dysfunctions as substrates of primary headaches. Biologie Aujourd'hui, 213, 43–49. - PubMed

Publication types