The prevalence of comorbid migraine in multiple sclerosis: do multiple sclerosis and migraine really coexist?

Multiple sclerosis (MS) is a chronic inflammatory disease causing multifocal demyelination and axonal damage in the central nervous system. Recent studies indicate that MS patients have a higher prevalence of migraine than the general population. This cross-sectional, single-centre study assessed migraine prevalence in MS patients receiving disease-modifying therapies (DMTs).

A total of 205 MS patients were included. All participants were assessed for migraine diagnosis according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), by a qualified physician. Migraine subtypes (episodic or chronic, with or without aura) were determined per ICHD-3 criteria. Each participant provided data on age, gender, current DMT type and duration, previous DMT history, MS-related symptoms, and MS relapses in the past 12 months.

Episodic migraine was identified in 36 patients, corresponding to a prevalence of 17.56% (95% CI (confidence interval): 12.4%-22.8%). Age-stratified analysis revealed higher prevalence in younger participants: 21.4% in those under 40 years (n = 98) compared to 14.0% in those aged 40 years or older (n = 107). The majority of cases (n = 28) presented without aura, with aura occurring in 8 patients. No chronic migraine was detected in the cohort. A total of 193 patients were diagnosed with relapsing-remitting multiple sclerosis (RRMS), 2 with secondary progressive MS (SPMS), and 10 with primary progressive MS (PPMS). No cases of progressive-relapsing MS (PRMS) were reported. Among the participants, 193 were receiving DMT, while 12 patients were not undergoing chronic immunotherapy. No significant correlations were found between migraine occurrence and MS type, type of DMT, disease duration, or Expanded Disability Status Scale (EDSS) score.

Migraine does not seem to be less common in MS patients compared to the general population but further, age-stratified and controlled studies are needed to investigate if it is more/as common.