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Migraine and tension-type headache in multiple sclerosis: A two-year, prospective, longitudinal, controlled study
Panagiotis Gklinos1, Maria-Eleftheria Evangelopoulos1, Georgios Velonakis2
1First Neurology Department, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Objective:
The primary aim of this study is to prospectively evaluate the prevalence of primary headache disorders in people with MS (pwMS) compared to healthy controls (HCs) over a two-year period and compare headache features between the two groups.
Background:
Several studies have found an increased prevalence of migraine in pwMS; however, most of them were cross-sectional or case-control in design, and relied on retrospective assessment of headache disorders, which introduces significant bias. Currently, there is no prospective study assessing primary headaches in pwMS longitudinally.
Methods:
This two-year, prospective, longitudinal, controlled study recruited consecutive pwMS attending the MS outpatient clinic of Eginition University Hospital in Athens, Greece, and age- and sex-matched HCs. Participants were assessed prospectively for headache disorders and their characteristics in four timepoints (every six months) for two years, using headache diaries.
Results:
Among 192 participants (96 pwMS and 96 HCs) who completed the study, the prevalence of any primary headache disorder was significantly higher in pwMS (60.4%) compared to HCs (41.7%) (p = 0.014). Migraine was more prevalent in pwMS (31.3%) than in HCs (16.7%) (p = 0.028), while the prevalence of tension-type headache (TTH) did not differ significantly between groups (34.4% in pwMS vs. 29.2% in HCs, p = 0.535). PwMS experienced more frequent, longer, and more intense headache attacks, with higher use of acute medication. Logistic regression showed pwMS were more likely to experience migraine and any headache compared to HCs (OR = 2.29; 95% CI: 1.13 - 4.64; p = 0.022 and OR = 2.3; 95% CI: 1.26 - 4.21; p = 0.007, respectively).
Conclusion:
Migraine is more prevalent and burdensome in pwMS compared to HCs, while TTH prevalence is similar between the groups. The prospective, longitudinal design, use of structured headache diaries, and inclusion of a matched control group strengthen the reliability of these findings and addresses the limitations of previous studies. These results highlight the need for further research into the mechanisms underlying the increased migraine prevalence in pwMS.
Insights
People with multiple sclerosis (MS) have a higher prevalence of primary headache disorders, particularly migraine, compared to healthy individuals. This prospective study highlights the increased burden of migraine in MS patients.
Area of Science:
- Neurology
- Epidemiology
- Headache Medicine
Background:
- Previous studies suggest a higher migraine prevalence in people with MS (pwMS), but often used retrospective designs with potential bias.
- No prospective, longitudinal studies have assessed primary headache disorders in pwMS.
Purpose of the Study:
- To prospectively evaluate the prevalence of primary headache disorders in pwMS versus healthy controls (HCs) over two years.
- To compare headache features and characteristics between pwMS and HCs.
Main Methods:
- A two-year prospective, longitudinal, controlled study involving 96 pwMS and 96 age/sex-matched HCs.
- Participants completed headache diaries every six months to track headache disorders and features.
Main Results:
- The prevalence of any primary headache disorder was significantly higher in pwMS (60.4%) than HCs (41.7%).
- Migraine was more prevalent in pwMS (31.3%) compared to HCs (16.7%), with pwMS experiencing more frequent, longer, and intense attacks.
- Tension-type headache prevalence did not significantly differ between groups.
Conclusions:
- Migraine is more prevalent and burdensome in pwMS than in HCs; tension-type headache prevalence is similar.
- The study's prospective design, use of diaries, and matched controls enhance reliability.
- Further research is needed to understand the mechanisms behind increased migraine prevalence in pwMS.
