Clinical Insights and Radiological Features on Multiple Sclerosis Comorbid with Migraine

Background: Multiple sclerosis (MS) and migraine are neurological diseases, affecting young women. Migraine is the most prevalent type of headache in people with MS (pwMS). Objectives: The aim of this review is to describe the clinical, radiological, and therapeutic features of MS and migraine comorbidity. The clinical section focuses on the characteristics of migraine in pwMS and of MS in co-occurrence with migraine, and on the presence of other possible comorbidities. The radiological section deals with the differential diagnosis of white matter lesions and changes in connectivity patterns on brain magnetic resonanceto investigate a possible link between MS and migraine. The therapeutic section evaluates the effects of MS-disease-modifying therapies on migraine and of prophylactic migraine treatments on MS. Methods: The literature search was conducted using PubMed as an electronic database. The papers that reported relevant clinical, radiological and therapeutic findings were selected. Results: Among 1351 results retrieved, at the end of screening procedures, 34 studies were selected. Migraine can impact the perception of some symptoms and the presence of some comorbidities, particularly relevant in MS. Furthermore, migraine and MS share some radiological features, leading to diagnostic challenges, however identifying some lesion characteristics and changes in the connectivity pathway may be supportive. Medications for migraine and MS should be administered considering both the adverse events and multiple drug interactions. Conclusions: The data emerging from this review illustrate the research efforts aimed at providing valuable insights into accurate diagnosis, effective clinical management, and the definition of targeted treatment schedules that could improve the quality of life for pwMS with migraine.