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Abdel Naseer M, Shehata HS, Khalil S, Fouad AM, Abdelghany H. Prevalence of primary headaches in multiple sclerosis patients. Mult Scler Relat Disord 2024; 86:105602. [PMID: 38598953 DOI: 10.1016/j.msard.2024.105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/11/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common immune-mediated inflammatory disease of the central nervous system. It is characterized by symptoms such as visual disturbances, paresis with spasticity, paresthesia, numbness, and fatigue. However, several studies have shown a high prevalence of headaches in individuals with MS. Migraine and tension-type headaches are the most frequent types of headaches experienced by those with MS. Additionally, the role of MS disease-modifying agents must be considered. These agents have different modes of action and side effect profiles, and their use may sometimes trigger headaches in patients with MS. OBJECTIVES This study aimed to explore the prevalence and clinical characteristics of primary headaches in MS patients. The relationship between headache and clinical features of MS (Course of MS, duration, EDSS, brain imaging and DMD) are also investigated. SUBJECTS AND METHODS Two hundred and eighty-one MS patients diagnosed according to according to the 2017 revisions to the McDonald Criteria were included in the study. Data was collected from the MS unit medical records and from the interview with the patients. Patients with reported headaches are asked to recall their headache characteristics and patterns using an interviewer administered Arabic language-structured validated questionnaire. RESULTS The median age of patients was 33 years old, with a range of 22-55. Tension-type headache (TTH) was more common in males, patients with more severe disability (EDSS ≥ 3), and those with SPMS and PPMS phenotypes. Additionally, patients on rituximab or cyclophosphamide therapy were more likely to have TTH. On the other hand, females, patients with milder disability (EDSS < 3), and those with RRMS phenotype were more likely to have migraine. This was also true for patients with MRI lesions involving the periaqueductal gray, and those receiving INF or fingolimod (P < 0.05). Periaqueductal gray matter lesions were found in the MRI of 48 patients (40 %) who experienced headaches on more than 10 days per month. Sensorimotor lesions in the brain were found in 55 patients (53.4 %) with severe headaches (p-value < 0.001). Interferons were associated with an increased risk of worsening preexisting headaches and the appearance of de novo headaches related to its intake (odds ratio: 2.84, 3.72; relative risk: 1.63, 2.04; p-value = 0.03, < 0.001, respectively). On the other hand, rituximab was associated with a decreased risk of worsening preexisting headaches and the appearance of de novo headaches related to its intake (odds ratio: 0.04, 0.09; relative risk: 0.11, 0.18; p-value = < 0.001, < 0.001, respectively). CONCLUSION Primary headaches are a common occurrence in patients with MS. Migraines and tension-type headaches (TTH) are among the most prevalent types. It has been observed that interferon can exacerbate preexisting headaches and even cause new ones. Additionally, the location of MS plaques may play a role in the frequency and severity of headaches.
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Affiliation(s)
| | | | - Sarah Khalil
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
| | | | - Hend Abdelghany
- Neurology Department, Faculty of Medicine, Cairo University, Egypt
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Sîrbu CA, Rotaru AR, Antochi FA, Plesa A, Manole AM, Roceanu AM. Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review. Life (Basel) 2024; 14:87. [PMID: 38255702 PMCID: PMC10817285 DOI: 10.3390/life14010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple sclerosis is a chronic and progressive neurological disease, with an important socio-economic burden. Over time, an increased incidence of headaches like migraines and tension headaches has been observed among these patients. Headaches have not been considered as multiple sclerosis-related symptoms, even representing a red flag for multiple sclerosis diagnosis. It is uncertain whether the headache-multiple sclerosis association could be explained by the presence of common triggers or a common physiopathological mechanism (involvement of tertiary B-cell follicles). An important differential diagnosis is between multiple sclerosis attacks and migraines with aura, which can also be associated with neurological deficits. Another important aspect is the occurrence or exacerbation of the cephalalgic syndrome after the initiation of therapy for multiple sclerosis (DMTs), or the improvement of headache after the initiation of certain DMT drugs. In addition to headaches, individuals diagnosed with multiple sclerosis often report experiencing diverse pain syndromes, contributing to an additional decline in their overall quality of life. These syndromes are frequently neglected, the focus being on slowing down the progression of neurological deficits. This review aims to evaluate the characteristics of multiple-sclerosis-related headaches (frequency, possible correlation with attacks, and disease-modifying therapies) and the key distinctions in imaging characteristics between demyelinating lesions in multiple sclerosis and those observed in cases of primary headaches.
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Affiliation(s)
- Carmen Adella Sîrbu
- Clinical Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania;
- Academy of Romanian Scientists, 050045 Bucharest, Romania
| | - Andreea Ruxandra Rotaru
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania;
| | | | - Andreea Plesa
- Doctoral School, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (A.M.M.)
| | - Aida Mihaela Manole
- Doctoral School, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (A.M.M.)
| | - Adina Maria Roceanu
- Neurology Department, University Emergency Hospital, 050098 Bucharest, Romania;
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Rościszewska-Żukowska I, Galiniak S, Bartosik-Psujek H. Clinical Characteristics of Headache in Multiple Sclerosis Patients: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12103518. [PMID: 37240624 DOI: 10.3390/jcm12103518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Primary headaches are known to be associated with multiple sclerosis (MS), but previous studies concerning this relationship are not conclusive. Nowadays, there are no studies assessing the prevalence of headaches in Polish MS patients. The aim of the study was to assess the prevalence and characterise headaches in MS patients treated with disease-modifying therapies (DMTs). In a cross-sectional study of 419 consecutive RRMS patients, primary headaches were diagnosed according to the International Classification of Headache Disorders (ICHD-3) criteria. Primary headaches were observed in 236 (56%) of RRMS patients, with a higher prevalence in women (ratio of 2:1). The most common was migraine 174 (41%) (migraine with aura 80 (45%), migraine without aura 53 (30%), and probable migraine without aura 41 (23%); less frequent was tension-type headache 62 (14%). Female sex was a risk factor for migraines but not for tension-type headaches (p = 0.002). Migraines mostly started before MS onset (p = 0.023). Migraine with aura was associated with older age, longer disease duration (p = 0.028), and lower SDMT (p = 0.002). Longer DMT time was associated with migraine (p = 0.047), particularly migraine with aura (p = 0.035). Typical for migraine with aura were headaches during clinical isolated syndrome (CIS) (p = 0.001) and relapses (p = 0.025). Age and type of CIS, oligoclonal band presence, family MS history, EDSS, 9HTP, T25FW, and type of DMT did not correlate with headache. Headaches are present in more than half of MS patients treated with DMTs; migraines occur almost three times more frequently than tension-type headaches. Migraines with aura headaches during CIS and relapses are typical. Migraine in MS patients had high severity and typical migraine characteristics. DMTs had no correlation with the presence or type of headache.
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Affiliation(s)
- Iwona Rościszewska-Żukowska
- St. Jadwiga Queen Clinical Hospital No. 2, Lwowska 60, 35-301 Rzeszow, Poland
- Institute of Medical Sciences, Medical College, Rzeszow University, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Sabina Galiniak
- Institute of Medical Sciences, Medical College, Rzeszow University, Warzywna 1a, 35-310 Rzeszow, Poland
| | - Halina Bartosik-Psujek
- St. Jadwiga Queen Clinical Hospital No. 2, Lwowska 60, 35-301 Rzeszow, Poland
- Institute of Medical Sciences, Medical College, Rzeszow University, Warzywna 1a, 35-310 Rzeszow, Poland
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4
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Salahi M, Parsa S, Nourmohammadi D, Razmkhah Z, Salimi O, Rahmani M, Zivary S, Askarzadeh M, Tapak MA, Vaezi A, Sadeghsalehi H, Yaghoobpoor S, Mottahedi M, Garousi S, Deravi N. Immunologic aspects of migraine: A review of literature. Front Neurol 2022; 13:944791. [PMID: 36247795 PMCID: PMC9554313 DOI: 10.3389/fneur.2022.944791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Migraine headaches are highly prevalent, affecting 15% of the population. However, despite many studies to determine this disease's mechanism and efficient management, its pathophysiology has not been fully elucidated. There are suggested hypotheses about the possible mediating role of mast cells, immunoglobulin E, histamine, and cytokines in this disease. A higher incidence of this disease in allergic and asthma patients, reported by several studies, indicates the possible role of brain mast cells located around the brain vessels in this disease. The mast cells are more specifically within the dura and can affect the trigeminal nerve and cervical or sphenopalatine ganglion, triggering the secretion of substances that cause migraine. Neuropeptides such as calcitonin gene-related peptide (CGRP), neurokinin-A, neurotensin (NT), pituitary adenylate-cyclase-activating peptide (PACAP), and substance P (SP) trigger mast cells, and in response, they secrete pro-inflammatory and vasodilatory molecules such as interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) as a selective result of corticotropin-releasing hormone (CRH) secretion. This stress hormone contributes to migraine or intensifies it. Blocking these pathways using immunologic agents such as CGRP antibody, anti-CGRP receptor antibody, and interleukin-1 beta (IL-1β)/interleukin 1 receptor type 1 (IL-1R1) axis-related agents may be promising as potential prophylactic migraine treatments. This review is going to summarize the immunological aspects of migraine.
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Affiliation(s)
- Mehrnaz Salahi
- Student Research Committee, School of Pharmacy and Pharmaceutical Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Parsa
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Delaram Nourmohammadi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Razmkhah
- Student Research Committee, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Salimi
- Student Research Committee, Faculty of Medicine, Islamic Azad University of Najafabad, Isfahan, Iran
| | | | - Saeid Zivary
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Monireh Askarzadeh
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Tapak
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Vaezi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Sadeghsalehi
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Yaghoobpoor
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Mottahedi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Setareh Garousi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Migraine, interferon β1a and siponimod immunomodulator therapies. BMC Anesthesiol 2022; 22:95. [PMID: 35382764 PMCID: PMC8981607 DOI: 10.1186/s12871-022-01639-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Autoimmunity seems to play a great role in the pathogenesis of migraine headache pain. There is far more evidence that interferon can exacerbate migraines. We report a case where remission of severe comorbid migraine attacks happened with the start of interferon β1a (Merck, Netherlands) immunomodulation therapy. Therapy for multiple sclerosis was decided according to the severity of the debilitating comorbid migraine headache pain rather than the evolution of multiple sclerosis the far more serious disease. Case presentation A 63-years old patient suffered for 30-years from migraine headache of severe disability assessment scale (MIDAS) Grade-IV = 27. He also suffered for 25-years from optic-sensory relapsing remitting multiple sclerosis (RRMS). Subcutaneous interferon β1a 44-µg immunomodulation therapy for 4-years resulted in multiple sclerosis complete remission. The start of interferon β1a therapy for multiple sclerosis seemed to help resolving the comorbid migraine attacks. The visual aura premonitory symptom preceding migraine headache would end up with a feeling of post visual aura clearer field of vision and a feeling of wellbeing. As the patient developed secondary progressive multiple sclerosis (SPMS), oral siponimod 2 mg (Novartis, Ireland), currently the only available therapy for SPMS, replaced his interferon therapy. This was associated with a relapse of migraine severe attacks. Reverting back to interferon therapy was again associated with migraine headache remission. Conclusions Interferon β1a might be an efficic therapy for “autoimmune migraine”. With numerous immunomodulators currently available for other systemic autoimmune diseases associated with comorbid migraine; examining the effect of these immunomodulatory therapies on comorbid migraine headache could be beneficial in finding a specific immunomodulator therapy for “autoimmune migraine”.
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6
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Spirin N, Kiselev D, Baranova N, Karpova M. Nociceptive and mixed pains in patients with multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:44-51. [DOI: 10.17116/jnevro202212207244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Silvestro M, Tessitore A, Orologio I, Sozio P, Napolitano G, Siciliano M, Tedeschi G, Russo A. Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine. J Clin Med 2021; 10:jcm10245914. [PMID: 34945208 PMCID: PMC8708794 DOI: 10.3390/jcm10245914] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
Vaccines have represented the breakthrough in the fight against COVID-19. Based on reported headache attacks after vaccination in randomized controlled trials, we focused on the effects of COVID-19 vaccine administration on the migraine population, using an online questionnaire published on Italian Facebook groups oriented to headache patients. We collected data about the demographics and clinical parameters of migraine severity, COVID-19 infection, vaccination, and characteristics of headaches following vaccination. Out of 841 migraine patients filling in the questionnaire, 66.47% and 60.15% patients experienced a headache attack (from 1 hour to 7 days) after the first and the second vaccine dose, respectively. The main finding concerns headaches perceived by 57.60% of patients: attacks following vaccination were referred to as more severe (50.62% of patients), long-lasting (52.80% of patients) and hardwearing (49.69% of patients) compared to the usually experienced migraine attacks. This could be related to the production of inflammatory mediators such as type Iβ interferon. Considering the high prevalence of migraine in the general population, awareness of the possibility of headaches worsening following COVID-19 vaccination in these patients may allow both patients and clinicians to face this clinical entity with conscious serenity, and to reduce the waste of resources towards inappropriate health-care.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Alessandro Tessitore
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Ilaria Orologio
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Pasquale Sozio
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Giuseppe Napolitano
- Intensity Care Unit, Department of Emergency and Acceptance “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Mattia Siciliano
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Gioacchino Tedeschi
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
| | - Antonio Russo
- Headache Center, Department of Advanced Medical and Surgical Sciences (DAMS), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.S.); (A.T.); (I.O.); (P.S.); (M.S.); (G.T.)
- Correspondence: ; Tel.: +39-081-5665119
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Biscetti L, De Vanna G, Cresta E, Corbelli I, Gaetani L, Cupini L, Calabresi P, Sarchielli P. Headache and immunological/autoimmune disorders: a comprehensive review of available epidemiological evidence with insights on potential underlying mechanisms. J Neuroinflammation 2021; 18:259. [PMID: 34749743 PMCID: PMC8573865 DOI: 10.1186/s12974-021-02229-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
Several lines of evidence support a role of the immune system in headache pathogenesis, with particular regard to migraine. Firstly, alterations in cytokine profile and in lymphocyte subsets have been reported in headache patients. Secondly, several genetic and environmental pathogenic factors seem to be frequently shared by headache and immunological/autoimmune diseases. Accordingly, immunological alterations in primary headaches, in particular in migraine, have been suggested to predispose some patients to the development of immunological and autoimmune diseases. On the other hand, pathogenic mechanisms underlying autoimmune disorders, in some cases, seem to favour the onset of headache. Therefore, an association between headache and immunological/autoimmune disorders has been thoroughly investigated in the last years. The knowledge of this possible association may have relevant implications in the clinical practice when deciding diagnostic and therapeutic approaches. The present review summarizes findings to date regarding the plausible relationship between headache and immunological/autoimmune disorders, starting from a description of immunological alteration of primary headaches, and moving onward to the evidence supporting a potential link between headache and each specific autoimmune/immunological disease.
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Affiliation(s)
- Leonardo Biscetti
- Istituto Nazionale di Riposo e Cura dell'Anziano a carattere scientifico, IRCSS- INRCA, Ancona, Italy
| | - Gioacchino De Vanna
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cresta
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Letizia Cupini
- Headache Center, UOC Neurologia-Stroke Unit, Emergency Department, Ospedale S. Eugenio, Rome, Italy
| | - Paolo Calabresi
- Department of Neuroscience, Università Cattolica Sacro Cuore, Rome, Italy
| | - Paola Sarchielli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache in multiple sclerosis - pharmacological aspects. Curr Pharm Des 2021; 28:445-453. [PMID: 34551691 DOI: 10.2174/1381612827666210922114100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/19/2021] [Indexed: 12/11/2022]
Abstract
For decades, headache was not considered a typical symptom of multiple sclerosis (MS) and was construed as a "red flag" for important differential diagnoses such as cerebral vasculitis. Meanwhile, several studies have demonstrated an increased prevalence of headache in MS compared to the general population. This is due to the heterogeneity of headache genesis with frequent occurrence of both primary and secondary headaches in MS. On the one hand, MS and migraine are often comorbid. On the other hand, secondary headaches occur frequently, especially in the course of MS relapses. These are often migraine-like headaches caused by inflammation, which can improve as a result of MS-specific therapy. Headaches are particularly common in the early stages of chronic inflammatory CNS disease, where inflammatory activity is greatest. In addition, headache can also occur as a side effect of disease-modifying drugs (DMDs). Headache can occur with most DMDs and is most frequently described with interferon-beta therapy. The aim of this work is to present the prevalence of headache and describe the heterogeneity of possible causes of headache in MS. In addition, important therapeutic aspects in the treatment of MS patients in general will be presented as well as different approaches to the treatment of headache in MS depending on the etiological classification.
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Affiliation(s)
- Marcel Gebhardt
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Neurologie, Röntgenstraße 1, 06120 Halle. Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Gehlsheimer Straße 20, 18147, Rostock. Germany
| | | | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock. Germany
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10
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Moisset X, Giraud P, Dallel R. Migraine in multiple sclerosis and other chronic inflammatory diseases. Rev Neurol (Paris) 2021; 177:816-820. [PMID: 34325914 DOI: 10.1016/j.neurol.2021.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Migraine is a very prevalent disease worldwide and is a major cause of disability. As known for a long time, migraine is associated with neurogenic inflammation. Epidemiological studies have shown that migraine is comorbid with several chronic inflammatory diseases, including multiple sclerosis (MS), chronic inflammatory rheumatic diseases (CIRDs) and inflammatory bowel diseases (IBDs). This brief narrative review highlights some recent data supporting a link between migraine and these three chronic inflammatory diseases. Studies found that migraine prevalence is approximately two-fold higher in these diseases compared to the general population. The causal link between migraine and these chronic inflammatory diseases has not been identified yet. Here, we suggest that systemic mediators (such as cytokines) and gut microbiome make migraine worse or add significant risks. Systemic inflammation biomarkers and gut microbiome modification are certainly avenues worth exploring.
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Affiliation(s)
- X Moisset
- Inserm, Neuro-Dol, Université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - P Giraud
- Annecy-Genevois Hospital, 74370 Annecy, France
| | - R Dallel
- Inserm, Neuro-Dol, Université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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11
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Altamura C, Corbelli I, de Tommaso M, Di Lorenzo C, Di Lorenzo G, Di Renzo A, Filippi M, Jannini TB, Messina R, Parisi P, Parisi V, Pierelli F, Rainero I, Raucci U, Rubino E, Sarchielli P, Li L, Vernieri F, Vollono C, Coppola G. Pathophysiological Bases of Comorbidity in Migraine. Front Hum Neurosci 2021; 15:640574. [PMID: 33958992 PMCID: PMC8093831 DOI: 10.3389/fnhum.2021.640574] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.
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Affiliation(s)
- Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Ilenia Corbelli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Policlinico General Hospital, Bari, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso B Jannini
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Messina
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Pasquale Parisi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,Headache Clinic, IRCCS-Neuromed, Pozzilli, Italy
| | - Innocenzo Rainero
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy
| | - Elisa Rubino
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Paola Sarchielli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Catello Vollono
- Department of Neurology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
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Mirmosayyeb O, Barzegar M, Nehzat N, Shaygannejad V, Sahraian MA, Ghajarzadeh M. The prevalence of migraine in multiple sclerosis (MS): A systematic review and meta-analysis. J Clin Neurosci 2020; 79:33-38. [DOI: 10.1016/j.jocn.2020.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
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Fragoso YD, Adoni T, Alves-Leon SV, Apostolos-Pereira SL, Carneiro MAD, Chikota EM, Diniz DS, Eboni ACB, Gomes S, Gonçalves MVM, Goncalves RP, Inojosa JL, Junqueira TF, Machado SC, Malfetano FR, Mansur LF, Mendes MF, Muniz A, Nobrega Junior AW, Olival GSD, Parolin MF, Pimentel MLV, Rocha CF, Ruocco HH, Santos GC, Siquineli F, Soares JOD, Sousa NAC, Tauil CB, Winckler TCA. Migraine in 746 patients with multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:617-621. [PMID: 31553391 DOI: 10.1590/0004-282x20190100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022]
Abstract
Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. METHODS Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. RESULTS The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. CONCLUSION Migraine is a frequent and disabling type of primary headache reported by patients with MS.
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Affiliation(s)
| | - Tarso Adoni
- Hospital Sírio-Libanês, São Paulo SP, Brazil
| | | | | | | | | | | | | | - Sidney Gomes
- Hospital Beneficência Portuguesa, São Paulo SP, Brazil
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Beckmann Y, Türe S. Headache characteristics in multiple sclerosis. Mult Scler Relat Disord 2019; 27:112-116. [DOI: 10.1016/j.msard.2018.09.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to discuss the prevalence, impact, pathophysiology, and treatment of headaches (H/As) in patients with multiple sclerosis (MS). RECENT FINDINGS Headaches and multiple sclerosis are more common in women than in men with the ratio of female to male being 3:1. It is not entirely clear if there is a correlation or an incidental comorbidity of two neurological conditions. A review of the literature shows a variable prevalence of H/As in MS patients. Using the International Classification of Headache Disorders (ICHD) criteria, the primary type of H/As, especially migraine, is the most common type seen in patients with MS. One of the theories of the pathophysiologic mechanisms of migraine in MS patients is inflammation leading to demyelinating lesions in the pain-producing centers in the midbrain. Secondary H/As due to MS medications such as interferons are also frequently present. H/As can be a cause for significant comorbidity in patients with MS. The treatment of H/As in patients with MS should be addressed in the same fashion as in the non-MS population, which is a combination of pharmacological and non-pharmacological methods. Preventive medicines for the H/As should be carefully selected because of their side effect profiles. Acute attacks of migraines can be treated with medications such as triptans. Patients with MS who have migraine H/As should be educated about the phenomenon of overuse H/As, keeping headache journals, avoiding stress, and monitoring sleeping habits. The presence of depression in patients with MS and migraine affects quality of life (QOL) and should also be addressed for better outcomes.
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Foley RW, Tagg NT, Schindler MK, Fenton KM, Reich DS, Cortese I, Mowry EM. Recurrent natalizumab-related aseptic meningitis in a patient with multiple sclerosis. Mult Scler 2017. [PMID: 28639536 DOI: 10.1177/1352458517702533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Natalizumab is a recombinant humanized monoclonal antibody that decreases T-cell migration into the central nervous system (CNS) through α4 integrin:adhesion-molecule inhibition, thereby increasing the risk for opportunistic CNS infection. Herein, we report a case of infusion-associated aseptic meningitis in a patient receiving natalizumab.
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Affiliation(s)
- Robert W Foley
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, University College Dublin, Dublin, Ireland
| | - Nathan T Tagg
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Matthew K Schindler
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Kaylan M Fenton
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA/Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Irene Cortese
- Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorder and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ellen M Mowry
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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de Jong HJI, Kingwell E, Shirani A, Cohen Tervaert JW, Hupperts R, Zhao Y, Zhu F, Evans C, van der Kop ML, Traboulsee A, Gustafson P, Petkau J, Marrie RA, Tremlett H. Evaluating the safety of β-interferons in MS: A series of nested case-control studies. Neurology 2017; 88:2310-2320. [PMID: 28500224 PMCID: PMC5567323 DOI: 10.1212/wnl.0000000000004037] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the association between interferon-β (IFN-β) and potential adverse events using population-based health administrative data in British Columbia, Canada. METHODS Patients with relapsing-remitting multiple sclerosis (RRMS) who were registered at a British Columbia Multiple Sclerosis Clinic (1995-2004) were eligible for inclusion and were followed up until death, absence from British Columbia, exposure to a non-IFN-β disease-modifying drug, or December 31, 2008. Incidence rates were estimated for each potential adverse event (selected a priori and defined with ICD-9/10 diagnosis codes from physician and hospital claims). A nested case-control study was conducted to assess the odds of previous IFN-β exposure for each potential adverse event with at least 30 cases. Cases were matched by age (±5 years), sex, and year of cohort entry, with up to 20 randomly selected (by incidence density sampling) controls. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated with conditional logistic regression adjusted for age at cohort entry. RESULTS Of the 2,485 eligible patients, 77.9% were women, and 1,031 were treated with IFN-β during follow-up. From the incidence analyses, 27 of the 47 potential adverse events had at least 30 cases. Patients with incident stroke (ORadj 1.83, 95% CI 1.16-2.89), migraine (ORadj 1.55, 95% CI 1.18-2.04), depression (ORadj 1.33, 95% CI 1.13-1.56), and hematologic abnormalities (ORadj 1.32, 95% CI 1.01-1.72) were more likely to have previous exposure to IFN-β than controls. CONCLUSIONS Among patients with RRMS, IFN-β was associated with a 1.8- and 1.6-fold increase in the risk of stroke and migraine and 1.3-fold increases in depression and hematologic abnormalities.
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Affiliation(s)
- Hilda J I de Jong
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Kingwell
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Afsaneh Shirani
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jan Willem Cohen Tervaert
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Raymond Hupperts
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yinshan Zhao
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Zhu
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Charity Evans
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mia L van der Kop
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anthony Traboulsee
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Gustafson
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John Petkau
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ruth Ann Marrie
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Tremlett
- From the Division of Neurology and Centre for Brain Health (H.J.I.d.J., E.K., A.S., Y.Z., F.Z., M.L.v.d.K., A.T., H.T.), Department of Medicine, and Vancouver Coastal Health Research Institute, University of British Columbia, Canada; School for Mental Health and Neuroscience (H.J.I.d.J., J.W.C.T., R.H.), Maastricht University Medical Center, the Netherlands; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon, Canada; Department Public Health Sciences (M.L.v.d.K.), Karolinska Institutet, Stockholm, Sweden; Department of Statistics (P.G., J.P.), University of British Columbia, Vancouver, Canada; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
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Increased contrast enhancing lesion activity in relapsing-remitting multiple sclerosis migraine patients. NEUROIMAGE-CLINICAL 2015; 9:110-6. [PMID: 26448911 PMCID: PMC4552815 DOI: 10.1016/j.nicl.2015.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/06/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
Abstract
Background and objectives While the literature supports the idea that multiple sclerosis (MS) and migraine are related, the exact mechanism(s) of this association is not well understood. Observations of increased contrast enhancing (CE) lesion activity in individual MS patients suffering from migraine prompted us to determine a relationship between migraine and MRI outcomes in a large cohort of MS patients. Methods We included 509 MS and 64 clinically isolated syndrome (CIS) patients and 251 age- and sex-matched healthy individuals (HIs) who obtained 3 T MRI and were assessed for history of migraine. Number and volume of T2, T1 and CE lesions and brain volume measures were determined. The MRI findings were analyzed adjusting for key covariates and correcting for multiple comparisons. Results More MS (22.2%) and CIS (17.2%) patients had migraine, compared to HIs (14.6%, p = 0.067). More MS patients with migraine presented with CE lesions compared to those without (35.4% vs. 23.7%, p = 0.013). MS migraine patients had significantly increased number (p = 0.019) and volume (p = 0.022) of CE lesions compared to those without. In the regression analysis, MS migraine patients had an increased number of CE lesions (B = 1.242, p = 0.001), specifically those with relapsing–remitting disease course (B = 1.377, p = 0.001). No significant association of other MRI measures and migraine was found in MS and CIS patients or in HIs. Conclusions Our findings suggest an increased inflammatory pathobiology in MS patients with migraine headaches requiring possibly more frequent MRIs and also more efficient anti-inflammatory treatment. We examined 509 MS and 64 CIS patients and 251 healthy individuals. Subjects were assessed with 3 T MRI and for history of migraine. More MS and CIS patients had migraine, compared to healthy controls. More MS migraine patients presented with enhancing brain lesions compared to those without. MS migraine patients had an increased number and volume of enhancing lesions.
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Lin GY, Wang CW, Chiang TT, Peng GS, Yang FC. Multiple sclerosis presenting initially with a worsening of migraine symptoms. J Headache Pain 2013; 14:70. [PMID: 23937696 PMCID: PMC3751257 DOI: 10.1186/1129-2377-14-70] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/08/2013] [Indexed: 01/03/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6–28.5%; however, it remains unclear whether headache is a true symptom of MS onset. Here, we report the case of a female patient who had a history of migraine without aura and experienced worsening of migraine-headache symptoms as the initial manifestation of MS. Three similar cases were reported previously; however, unlike this case, those cases had no history of migraine without aura. In our case, we excluded factors that could trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger. The patient had one episode of MS attack with the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions, including hyperintense lesions in the bilateral periventricular white matter, body of the corpus callosum, and periaqueductal grey matter, as observed on the T2-weighted images obtained at the first brain magnetic resonance imaging. In addition, after the injection of gadolinium contrast, ring enhancement over these lesions was noted in T1-weighted images, which was suggestive of active demyelination. MS was diagnosed according to the McDonald criteria (2010 revision). We conclude that MS with periaqueductal grey matter involvement may present with worsening migraine. It is important to be cautious if any secondary causes exist, especially when the patient has a history of migraine without aura. MS should be one of the differential diagnoses in young women showing a change in headache pattern or poor clinical drug response to migraine treatment accompanied by episodes of focal neurological deficit. Failure to recognize MS may lead to inappropriate treatment and worse prognosis; early diagnosis in patients with MS is essential to improve their clinical outcomes and quality of life.
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Affiliation(s)
- Guan-Yu Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Truini A, Barbanti P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. J Neurol 2013; 260:351-67. [PMID: 22760942 PMCID: PMC3566383 DOI: 10.1007/s00415-012-6579-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/31/2012] [Accepted: 06/03/2012] [Indexed: 12/30/2022]
Abstract
Pharmacological treatment of pain in multiple sclerosis (MS) is challenging due to the many underlying pathophysiological mechanisms. Few controlled trials show adequate pain control in this population. Emerging evidence suggests that pain might be more effectively classified and treated according to symptoms and underlying mechanisms. The new mechanism-based classification we propose here distinguishes nine types of MS-related pain: trigeminal neuralgia and Lhermitte's phenomenon (paroxysmal neuropathic pain due to ectopic impulse generation along primary afferents), ongoing extremity pain (deafferentation pain secondary to lesion in the spino-thalamo-cortical pathways), painful tonic spasms and spasticity pain (mixed pains secondary to lesions in the central motor pathways but mediated by muscle nociceptors), pain associated with optic neuritis (nerve trunk pain originating from nervi nervorum), musculoskeletal pains (nociceptive pain arising from postural abnormalities secondary to motor disorders), migraine (nociceptive pain favored by predisposing factors or secondary to midbrain lesions), and treatment-induced pains. Identification of various types of MS-related pain will allow appropriate targeted pharmacological treatment and improve clinical practice.
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Affiliation(s)
- A. Truini
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- Don Gnocchi Foundation, Milan, Italy
| | | | - C. Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- MS Center, S. Andrea Hospital, Rome, Italy
| | - G. Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Viale Università 30, 00185 Rome, Italy
- San Raffaele IRCCS, Rome, Italy
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Pakpoor J, Handel AE, Giovannoni G, Dobson R, Ramagopalan SV. Meta-analysis of the relationship between multiple sclerosis and migraine. PLoS One 2012; 7:e45295. [PMID: 23024814 PMCID: PMC3443216 DOI: 10.1371/journal.pone.0045295] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
Abstract
Background Studies investigating a proposed association between multiple sclerosis (MS) and migraine have produced conflicting results and a great range in the prevalence rate of migraine in MS patients. By meta-analysing all available data we aimed to establish an overall estimate of any association in order to more accurately inform clinicians and care-givers about a potential association between MS and migraine. Methods Pubmed and EMBASE were searched to identify suitable studies. Studies were included if they were a case-control study or cohort study in which controls were not reported to have another neurological condition, were available in English, and specified migraine as a headache sub-type. The odds ratio (OR) of migraine in MS patients vs. controls was calculated using the inverse variance with random effects model in Review Manager 5.1. Results Eight studies were selected for inclusion, yielding a total of 1864 MS patients and 261563 control subjects. We found a significant association between migraine and MS (OR = 2.60, 95% CI 1.12–6.04), although there was significant heterogeneity. Sensitivity analysis showed that migraine without aura was associated with MS OR = 2.29 (95% CI 1.14–4.58), with no significant heterogeneity. Conclusions MS patients are more than twice as likely to report migraine as controls. Care providers should be alerted to ask MS patients about migraine in order to treat it and potentially improve quality of life. Future work should further investigate the temporal relationship of this association and relationship to the clinical characteristics of MS.
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Affiliation(s)
- Julia Pakpoor
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, The West Wing, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adam E. Handel
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, The West Wing, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gavin Giovannoni
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Ruth Dobson
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- * E-mail: (SVR); (RD)
| | - Sreeram V. Ramagopalan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, United Kingdom
- Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, The West Wing, John Radcliffe Hospital, Oxford, United Kingdom
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: (SVR); (RD)
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Villani V, De Giglio L, Sette G, Pozzilli C, Salvetti M, Prosperini L. Determinants of the severity of comorbid migraine in multiple sclerosis. Neurol Sci 2012; 33:1345-53. [DOI: 10.1007/s10072-012-1119-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/12/2012] [Indexed: 11/28/2022]
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