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Cluster Headache as the Index Event in MS: A Case Report
Jonathan Benjamin Pelikan1, Jennifer A McCombe2, Trevor Kotylak3
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Headache
|February 9, 2016
Summary
Cluster-like headaches can be an initial symptom of new-onset multiple sclerosis (MS). A brain lesion in the brachium pontis may contribute to these cluster headache attacks in MS patients.
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Cluster headache (CH) is a distinct primary headache disorder.
- Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
Observation:
- A 42-year-old woman presented with cluster-like headaches and other neurological symptoms, later diagnosed with new-onset MS.
- Her headaches were ipsilateral, accompanied by lacrimation, nasal congestion, facial numbness, and ataxia.
Findings:
- A large demyelinating lesion was identified in the brachium pontis contralateral to the headache side.
- Additional supratentorial lesions were also present.
- Cluster-like headache attacks ceased after initiating dimethyl fumarate treatment.
Implications:
- This case suggests cluster-like headaches can be a presenting symptom of MS.
- Lesions in the brachium pontis may play a role in generating CH in MS.
- Highlights the importance of considering MS in patients with atypical headache presentations.
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