Headache in the first manifestation of Multiple Sclerosis – Prospective, multicenter study. Issue 12 (16th November 2017)

• Record Type: Journal Article
• Authors: Gebhardt, Marcel; Kropp, Peter; Jürgens, Tim P.; Hoffmann, Frank; Zettl, Uwe K.
• Is Part Of: Brain and behavior. Volume 7:Issue 12(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-11-16
• Subjects: clinically isolated syndrome -- headache -- migraine -- multiple sclerosis -- radiologically isolated syndrome; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.852
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Objectives: Multiple sclerosis (MS) is the most frequent immune‐mediated inflammation of the central nervous system that can lead to early disability. Headaches have not been considered as MS‐related symptoms initially, whereas higher prevalence rates were reported since 2000. Postmortem histological analyses of MS patients' brains revealed lymphoid follicle‐like structures in the cerebral meninges which suggest a possible pathophysiological explanation for the high headache prevalence in MS. The aim of this study was to evaluate headache characteristics during the first clinical event of MS. Methods: In a prospective, multicenter study, 50 patients with the diagnosis of CIS or MS were recruited. All participants were screened for the presence of headache within the last 4 weeks with help of the Rostock Headache Questionnaire (Rokoko). Results: Thirty‐nine of fifty questioned patients (78%) reported headaches within the last 4 weeks. Most patients suffered from throbbing and pulsating headaches (25, 50%), 15 (30%) reported stabbing, 14 (28%) dull and constrictive headaches. Conclusions: Headaches were prevalent in 78% of patients in our population with newly diagnosed CIS and MS. It is among the highest prevalence rates reported so far in patients with CIS or MS. Thus, headache, especially of a migraneous subtype, is a frequent symptom within the scope of the first manifestation of multiple sclerosis. If it were possible to define a MS‐typical headache, patients with these headaches and with typical MRI results would be classified as CIS or early MS instead of radiologically isolated syndrome and treated accordingly with an immunomodulatory therapy. Abstract : In a prospective, multicenter study on 50 patients with the initial diagnosis of clinically isolated syndromes (CIS) or multiple sclerosis (MS), we found the high prevalence of headache of 78%. This could well be due to the fact that we recruited only patients at the time of presenting first neurological symptoms. We suspect a pathophysiological link between migraine (as the most common headache found in our patients) and the high inflammatory activity especially in the initial phase of MS.