Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review

Area of Science:

• Neurology
• Neuroimmunology

Background:

• Multiple sclerosis (MS) is a chronic neurological disease with significant socio-economic impact.
• Increased incidence of headaches, such as migraines and tension headaches, is noted in MS patients.
• Headaches are often overlooked as MS symptoms, despite potentially indicating the disease or treatment side effects.

Purpose of the Study:

• To evaluate characteristics of MS-related headaches, including frequency, correlation with MS attacks, and impact of disease-modifying therapies (DMTs).
• To differentiate between MS demyelinating lesions and primary headache imaging findings.
• To explore potential shared triggers or pathophysiological mechanisms between MS and headaches.

Main Methods:

• Literature review focusing on epidemiological data, clinical observations, and neuroimaging studies.
• Analysis of diagnostic challenges, particularly distinguishing MS attacks from migraines with aura.
• Examination of headache occurrence/exacerbation with DMT initiation and potential improvement with certain DMTs.

Main Results:

• Headaches are a frequent, yet often neglected, symptom in multiple sclerosis, impacting quality of life.
• Differential diagnosis between MS attacks and migraines with aura is crucial due to overlapping neurological symptoms.
• Therapeutic interventions for MS can influence headache presentation, with some DMTs potentially improving headache symptoms.

Conclusions:

• Further research is needed to elucidate the pathophysiological link between MS and headaches.
• Understanding the relationship between MS, headaches, and their treatments is vital for comprehensive patient care.
• Distinguishing imaging characteristics of MS lesions from those in primary headaches is essential for accurate diagnosis.