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Published on: July 19, 2019
Headache in the first manifestation of Multiple Sclerosis - Prospective, multicenter study
Marcel Gebhardt1, Peter Kropp2, Tim P Jürgens3
1Krankenhaus Martha-Maria Halle-Dölau Halle Germany.
Objectives:
Multiple sclerosis (MS) is the most frequent immune-mediated inflammation of the central nervous system that can lead to early disability. Headaches have not been considered as MS-related symptoms initially, whereas higher prevalence rates were reported since 2000. Postmortem histological analyses of MS patients' brains revealed lymphoid follicle-like structures in the cerebral meninges which suggest a possible pathophysiological explanation for the high headache prevalence in MS. The aim of this study was to evaluate headache characteristics during the first clinical event of MS.
Methods:
In a prospective, multicenter study, 50 patients with the diagnosis of CIS or MS were recruited. All participants were screened for the presence of headache within the last 4 weeks with help of the Rostock Headache Questionnaire (Rokoko).
Results:
Thirty-nine of fifty questioned patients (78%) reported headaches within the last 4 weeks. Most patients suffered from throbbing and pulsating headaches (25, 50%), 15 (30%) reported stabbing, 14 (28%) dull and constrictive headaches.
Conclusions:
Headaches were prevalent in 78% of patients in our population with newly diagnosed CIS and MS. It is among the highest prevalence rates reported so far in patients with CIS or MS. Thus, headache, especially of a migraneous subtype, is a frequent symptom within the scope of the first manifestation of multiple sclerosis. If it were possible to define a MS-typical headache, patients with these headaches and with typical MRI results would be classified as CIS or early MS instead of radiologically isolated syndrome and treated accordingly with an immunomodulatory therapy.
Insights
Headaches are a common symptom in newly diagnosed multiple sclerosis (MS) and clinically isolated syndrome (CIS), affecting 78% of patients. Migrainous headaches are particularly frequent during the initial presentation of MS.
Area of Science:
- Neurology
- Immunology
- Neuroinflammation
Background:
- Multiple sclerosis (MS) is a primary immune-mediated central nervous system inflammatory disease.
- Headaches, once overlooked, are increasingly recognized as a significant symptom in MS, with higher prevalence reported since 2000.
- Cerebral meningeal lymphoid structures in MS patients suggest a link between inflammation and headaches.
Purpose of the Study:
- To investigate the characteristics of headaches during the first clinical event of MS.
- To assess the prevalence of headaches in patients with clinically isolated syndrome (CIS) or MS.
Main Methods:
- Prospective, multicenter study involving 50 patients diagnosed with CIS or MS.
- Headache screening within the past 4 weeks using the Rostock Headache Questionnaire (Rokoko).
Main Results:
- A high prevalence of headaches was reported, with 78% (39 out of 50) of patients experiencing them.
- Common headache types included throbbing/pulsating (50%), stabbing (30%), and dull/constrictive (28%).
Conclusions:
- Headache is a highly prevalent symptom in newly diagnosed CIS and MS patients, particularly of the migrainous subtype.
- Identifying a typical MS-related headache could aid in early diagnosis and treatment of CIS/MS, differentiating it from radiologically isolated syndrome.
- Early identification and immunomodulatory therapy are crucial for patients presenting with MS-typical headaches and relevant MRI findings.
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