Are Headaches a Symptom of MS? Types, Causes, and Treatments Explained

17.11.197111.08.2021 by alexxlab

How are headaches related to multiple sclerosis. What types of headaches are common in MS patients. Can MS medications cause headaches. How are MS-related headaches diagnosed and treated.

Содержание

Types of Headaches Associated with Multiple Sclerosis

Multiple sclerosis (MS) patients often experience various types of headaches. Research indicates that people with MS may be more susceptible to certain headache disorders compared to the general population. A study revealed that 78% of newly diagnosed MS patients reported experiencing headaches in the month prior to diagnosis. The three primary headache types associated with MS are:

Migraines
Cluster headaches
Tension headaches

It’s worth noting that women are twice as likely to experience headaches, migraines, and severe jaw or facial pain (a characteristic symptom of MS) than men, according to the Centers for Disease Control and Prevention (CDC).

Migraines in MS Patients

Migraines are particularly common in individuals with relapsing-remitting MS. These headaches typically last between 4 and 72 hours and have distinct characteristics:

Often preceded by prodrome symptoms or an aura
Throbbing pain on one or both sides of the head
Sensitivity to light and sound
Nausea, vomiting, or loss of appetite
Residual pain and discomfort after the main episode

Cluster Headaches and MS

Cluster headaches are characterized by severe, piercing pain typically localized to one side of the nose or deep in one eye. These headaches have unique features:

Rapid onset of pain
Sensation of electric shocks or “explosions” behind the eye
Unilateral occurrence
No warning signs (unlike migraines)
Often recur at the same time daily
May cause eye watering, nasal discharge, or eyelid drooping

Tension Headaches in MS Patients

Tension headaches are the most prevalent type of headache in the general population and are also common among MS patients. They have the following characteristics:

Duration ranging from 30 minutes to several days
Usually cause mild to moderate pain
Sensation of constant, band-like pressure around the head
Gradual onset
Typically occur later in the day

Symptoms and Impact of MS-Related Headaches

The symptoms and impact of headaches in MS patients can vary depending on the type of headache experienced. Understanding these symptoms can help in better management and treatment.

Migraine Symptoms and Their Impact

Migraine headaches can be debilitating for MS patients. The primary symptoms include:

Intense, throbbing pain
Heightened sensitivity to light and sound
Nausea and vomiting
Visual disturbances (aura)

The impact of migraines on MS patients can be significant. Many individuals find themselves needing to retreat to a quiet, dark space for hours during an episode. Even after the migraine subsides, patients often experience a postdrome phase characterized by:

Fatigue
Irritability
Difficulty concentrating
Dizziness

Cluster Headache Symptoms and Their Effects

Cluster headaches are often described as excruciatingly painful. Patients frequently report:

Intense, burning pain behind one eye
Restlessness and agitation during attacks
Extreme distress and anxiety

The impact of cluster headaches extends beyond the pain itself. Many patients experience:

Fear and dread of future attacks
Interference with daily activities and social interactions
Insomnia due to anxiety about nighttime attacks
Exhaustion following each headache episode

Tension Headache Symptoms in MS

While generally less severe than migraines or cluster headaches, tension headaches can still significantly impact MS patients. Common symptoms include:

Dull, aching pain
Feeling of pressure or tightness across the forehead or sides of the head
Tenderness in scalp, neck, and shoulder muscles

The persistent nature of tension headaches can lead to:

Decreased productivity
Difficulty concentrating
Increased fatigue
Irritability and mood changes

Causes of Headaches in Multiple Sclerosis Patients

Understanding the underlying causes of headaches in MS patients is crucial for effective management and treatment. Several factors can contribute to the development of headaches in individuals with MS:

MS Lesions and Their Role in Headache Development

Research has suggested a potential link between MS lesions in the brain and an increased frequency of migraines and tension-type headaches. Some key points to consider:

Acute MS relapses may manifest with headache or migraine as the primary symptom
Cluster headaches have been associated with MS lesions in the brainstem, particularly in the region where the trigeminal nerve originates
The trigeminal nerve is also involved in trigeminal neuralgia, one of the most painful MS symptoms

However, it’s important to note that the relationship between MS lesions and headaches is not conclusively established. Some studies have found no increased risk of migraines or tension headaches in MS patients compared to the general population.

MS Medications as Headache Triggers

Certain medications used to treat MS can potentially cause headaches or exacerbate existing ones. These include:

Interferon-based disease-modifying therapies:

Rebif (interferon ß-1a)
Betaseron (interferon ß-1b)
Avonex (interferon ß-1a)

Other disease-modifying medications may also induce headaches as a side effect. It’s crucial for patients to discuss any new or worsening headaches with their healthcare provider, as medication adjustments may be necessary.

Other Potential Causes of Headaches in MS

Several other factors can contribute to headaches in MS patients:

Stress and anxiety related to managing a chronic condition
Fatigue, which is common in MS and can trigger headaches
Changes in sleep patterns or insomnia
Dehydration, which can be more common in MS patients due to bladder issues
Hormonal fluctuations, particularly in women with MS

Diagnosis of Headaches in MS Patients

Accurately diagnosing headaches in MS patients is essential for proper treatment and management. The diagnostic process typically involves several steps:

Medical History and Symptom Assessment

Healthcare providers will conduct a thorough evaluation of the patient’s medical history, including:

Detailed description of headache symptoms
Frequency and duration of headaches
Potential triggers or exacerbating factors
Impact on daily life and functioning
History of MS symptoms and treatments

Physical and Neurological Examination

A comprehensive physical and neurological exam may be performed to:

Assess cranial nerve function
Evaluate muscle strength and coordination
Check for signs of increased intracranial pressure
Identify any new or worsening MS symptoms

Diagnostic Imaging

In some cases, additional imaging studies may be necessary:

MRI scans to detect new or active MS lesions
CT scans to rule out other potential causes of headaches

These imaging studies can help differentiate between MS-related headaches and those caused by other conditions.

Headache Diaries

Patients may be asked to maintain a headache diary to track:

Frequency and intensity of headaches
Potential triggers
Response to medications or other treatments

This information can be valuable in determining the most effective treatment approach.

Treatment Options for Headaches in MS Patients

Managing headaches in MS patients often requires a multifaceted approach. Treatment strategies may include:

Pharmacological Interventions

Medications used to treat headaches in MS patients can be categorized into two main groups:

Acute treatments:

Over-the-counter pain relievers (e.g., ibuprofen, acetaminophen)
Triptans for migraine relief
Anti-nausea medications

Preventive treatments:

Beta-blockers
Anticonvulsants
Calcium channel blockers
CGRP antagonists for chronic migraines

The choice of medication depends on the type of headache, its frequency, and the individual patient’s needs and tolerances.

Non-Pharmacological Approaches

Several non-drug therapies can be effective in managing headaches:

Stress reduction techniques (e.g., meditation, deep breathing exercises)
Regular exercise and physical therapy
Acupuncture
Cognitive-behavioral therapy
Biofeedback

Lifestyle Modifications

Certain lifestyle changes can help reduce the frequency and severity of headaches:

Maintaining a regular sleep schedule
Staying hydrated
Avoiding known triggers (e.g., certain foods, bright lights)
Managing stress through relaxation techniques
Limiting caffeine and alcohol intake

Addressing MS-Specific Factors

For headaches related to MS treatments or symptoms:

Adjusting MS medications if they are triggering headaches
Managing MS-related fatigue to prevent tension headaches
Treating any underlying sleep disorders

The Relationship Between MS Progression and Headache Patterns

Understanding how headache patterns may change as MS progresses is crucial for long-term management. Several factors can influence this relationship:

Changes in Headache Frequency and Intensity

As MS progresses, patients may experience:

Increased frequency of headaches during periods of disease activity
Changes in headache type (e.g., from episodic to chronic migraines)
Alterations in pain intensity or duration

Regular monitoring and communication with healthcare providers can help track these changes and adjust treatment plans accordingly.

Impact of MS Lesions on Headache Patterns

The development of new MS lesions or the expansion of existing ones may influence headache patterns:

Lesions in specific areas of the brain may trigger new types of headaches
Changes in brain structure due to MS progression could alter pain perception
Inflammation associated with active lesions may exacerbate headache symptoms

Medication-Related Changes

As MS treatment regimens evolve over time, headache patterns may be affected:

Switching to new disease-modifying therapies may introduce or alleviate headache symptoms
Long-term use of certain medications may lead to medication overuse headaches
Adjustments in symptom management medications can impact headache frequency and severity

Psychological Factors and Disease Progression

The psychological impact of MS progression can influence headache experiences:

Increased stress and anxiety about disease progression may trigger more frequent headaches
Depression, which is common in MS, can exacerbate headache symptoms
Coping strategies may need to evolve as the disease progresses to manage headache-related distress

Emerging Research and Future Directions in MS-Related Headaches

The field of MS-related headache research is continuously evolving. Several areas of investigation show promise for improving our understanding and treatment of headaches in MS patients:

Biomarker Studies

Researchers are exploring potential biomarkers that could:

Predict the likelihood of developing MS-related headaches
Indicate the most effective treatment approaches for individual patients
Help differentiate between MS-related headaches and primary headache disorders

Advanced Neuroimaging Techniques

New imaging technologies may provide insights into:

The relationship between MS lesion location and headache types
Functional brain changes associated with headaches in MS patients
Potential structural differences in the brains of MS patients with and without chronic headaches

Novel Treatment Approaches

Emerging therapies under investigation include:

Neuromodulation techniques for headache prevention and treatment
Targeted therapies addressing both MS progression and headache symptoms
Personalized medicine approaches based on genetic and biomarker profiles

Longitudinal Studies

Long-term studies are needed to:

Track changes in headache patterns throughout the course of MS
Identify factors that predict the development or worsening of headaches in MS patients
Evaluate the long-term efficacy and safety of various headache treatments in the MS population

As research in this field progresses, it is likely that our understanding of the complex relationship between MS and headaches will continue to improve, leading to more effective and personalized treatment strategies for MS patients experiencing headaches.

Types, Symptoms, Causes, Diagnosis, Treatments

Some research suggests that people with multiple sclerosis (MS) are more prone to migraines and other headache disorders, like tension headaches or cluster headaches, than the general population.

One study found that 78% of participants with newly diagnosed MS reported having headaches in the past month.

Verywell / JR Bee

Headache Types

There are three types of primary headache disorders that have been evaluated as being potentially linked to multiple sclerosis: migraines, cluster headaches, and tension headaches.

According to the Centers for Disease Control and Prevention (CDC), women are twice as likely to experience headaches, migraines, and severe jaw or facial pain (a characteristic symptom of MS) than men.

Migraines

Migraines are common in people with relapsing-remitting MS. They last between four and 72 hours and have some of the following features:

Preceded by prodrome symptoms (including fatigue, hunger, or anxiety) or an aura (blurry or distorted vision signaling that a headache is about to begin)
Throbbing on one or both sides of the head
Accompanied by sensitivity to light or sound
Accompanied by nausea, vomiting, or loss of appetite
Followed by residual pain and discomfort

Some people find that a long nap following a migraine helps relieve some residual symptoms.

Cluster Headaches

Cluster headaches begin as a severe throbbing, piercing, or burning sensation on one side of the nose or deep in one eye. They can last only 15 minutes or as long as three hours.

Characteristically, the pain:

Peaks rapidly
Feels like electric shocks or “explosions” in or behind the eye
Occurs only on one side of the face
Comes on without warning (unlike many migraines)
Tends to recur at the same time every day (often soon after falling asleep), usually for a period of several weeks
Can cause eyes to water, nose to run, or eyelids to droop
Completely resolves (until the next cluster headache)

Tension Headaches

Tension headaches are the most common type of headache in the general population. Their duration can be 30 minutes to all day (or even up to one week).

Tension-type headaches also:

Rarely cause severe pain; it’s most often moderate or mild
Feel like a constant, band-like aching or squeezing sensation that is either right over the eyebrows or encircling the head
Come on gradually
Can happen during any part of the day, but typically occur in the latter part of the day

Symptoms

Migraine headaches can be incredibly painful, and the accompanying light and sound sensitivity can lead to people withdrawing to a quiet, dark space for hours at a time.

Even when the migraine episode has passed, people are often left with residual symptoms—called the postdrome phase—which includes fatigue, irritability, problems concentrating, and dizziness.

People often describe cluster headaches as the worst pain they could imagine, akin to plunging a burning ice pick into their eye. The pain of them causes many people to fall on the floor, pull at their hair, rock back and forth, scream, and weep.

Although the pain from cluster headaches resolves and has no lingering effect like with migraines, people often feel completely exhausted after each headache.

Just as disabling as the headaches are the fear and dread that people feel knowing there is a good chance another one is coming. This anxiety can interfere with daily activities or social contact, as well as lead to insomnia.

Causes

Many different things can cause headaches in people with MS, some of which are directly related to the disease and others of which are residual side effects of treatment.

MS lesions

Some research suggests an association between MS lesions in the brain and an increased number of migraines and/or tension-type headaches. In addition, some people undergoing an acute MS relapse report a headache or migraine being the main symptom.

Cluster headaches have been linked to MS lesions in the brainstem, especially in the part where the trigeminal nerve originates. This is the nerve involved with trigeminal neuralgia—one of the most painful MS symptoms.

However, other studies suggest there is no link between MS and either migraines or tension headaches.

One case-control study in Norway involving over 1,750 participants found no increased risk of migraines or tension headaches in people with MS compared to the general population.

MS Medications

Interferon-based disease-modifying therapies can cause headaches or make pre-existing headaches worse. These drugs include:

Rebif (interferon ß-1a)
Betaseron (interferon ß-1b)
Avonex (interferon ß-1a)

Other disease-modifying medications may cause headaches as well, including:

Other

Headaches are also common during episodes of optic neuritis. These headaches are usually only on one side and worsen when the affected eye is moved.

Depression, a common MS symptom, has also been associated with headaches. Depression and migraine headaches are both linked to low serotonin levels.

When to See Your Doctor

You should see your doctor for any type of an unusual headache, a headache that keeps recurring, or one that lasts for a long time.

Diagnosis

When evaluating your headache, your doctor will first likely ask you several specific questions about your headache in order to narrow down the diagnosis. These questions include:

Location: Where is the pain located?
Character: How would you describe your headache? (e.g. throbbing, aching, burning, sharp)
Severity: What is your pain on a scale of 1 to 10, with 10 being the worst pain of your life? Would you describe your headache as mild, moderate, or severe? Is this your worst headache ever?
Exacerbating or alleviating factors: What makes the pain better or worse?
Radiation: Does the pain radiate?
Onset: Was the onset of your head pain rapid or gradual?
Duration: How long has the pain been going on? Is it constant or intermittent?
Associations: Are there other symptoms associated with your headache? (e. g. nausea, vomiting, visual changes)

In addition, your healthcare provider will make note of your personal and family medical history, any medications you are taking, and your social habits (e.g. caffeine intake, alcohol use, smoking).

In the case of an extremely severe headache that comes on suddenly and has not occurred previously, brain imaging tests may be done to rule out a tumor or stroke.

Treatment

Doctors treat headaches based on the cause. If the headache is the result of a drug side effect, you doctor may be able to substitute the offending drug or change the dosage.

At other times, painkillers may be prescribed to help alleviate the symptoms.

Commonly prescribed options include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen) and Advil or Motrin (ibuprofen), are usually the first-line defense in treating tension headaches and migraines.
Antidepressants known as serotonin norepinephrine reuptake inhibitors (SNRIs), including Effexor (venlafaxine). Both depression and migraines are linked to low serotonin levels, so making more serotonin available to your brain may improve both symptoms over time.
Triptans are class of drugs used specifically to treat migraines and cluster headaches. They bind to serotonin receptors in the brain, blocking certain pain pathways and narrowing blood vessels.
High-dose steroids can cause headaches in some, but the same drugs can be effective in treating headaches related to MS relapse. If headaches are associated with optic neuritis or induced by an MS lesion, a course of Solu-Medrol can often help alleviate chronic or acute headache pain.

A Word From Verywell

It’s helpful to keep a symptom log where you record the specifics of your headaches, including:

The time of day they started
How long they lasted
Any triggers you might have noticed
Anything that helped, including medications

This will help your doctor to determine what might be causing the headaches, what type they are, and what kind of treatment to try.

Headache in the first manifestation of Multiple Sclerosis – Prospective, multicenter study

Brain Behav. 2017 Dec; 7(12): e00852.

,¹,²,³,¹ and ⁴

Marcel Gebhardt

¹
Krankenhaus Martha‐Maria Halle‐Dölau,
Halle,
Germany,

Peter Kropp

²
Institute of Medical Psychology and Medical Sociology,
Medical Faculty,
University of Rostock,
Rostock,
Germany,

Tim P. Jürgens

³
Department of Neurology,
University Medical Center Rostock,
Rostock,
Germany,

Frank Hoffmann

¹
Krankenhaus Martha‐Maria Halle‐Dölau,
Halle,
Germany,

Uwe K. Zettl

⁴
Department of Neurology,
Neuroimmunological Section,
University of Rostock,
Rostock,
Germany,

¹
Krankenhaus Martha‐Maria Halle‐Dölau,
Halle,
Germany,

²
Institute of Medical Psychology and Medical Sociology,
Medical Faculty,
University of Rostock,
Rostock,
Germany,

³
Department of Neurology,
University Medical Center Rostock,
Rostock,
Germany,

⁴
Department of Neurology,
Neuroimmunological Section,
University of Rostock,
Rostock,
Germany,

Corresponding author. ^*Correspondence
Marcel Gebhardt, Klinik für Neurologie, Krankenhaus Martha‐Maria Halle‐Dölau, Halle, Germany.
Email: [email protected],

Received 2017 Jun 17; Revised 2017 Sep 6; Accepted 2017 Sep 10.

Copyright © 2017 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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

Keywords: clinically isolated syndrome, headache, migraine, multiple sclerosis, radiologically isolated syndrome

1. INTRODUCTION

Multiple sclerosis (MS) is the most frequent immune‐mediated inflammation of the central nervous system (CNS) that can lead to early disability (Flachenecker et al., 2008). In 2013, the worldwide MS prevalence was 2.3 million (Browne et al., 2014). The mean age at the first clinical manifestation of MS typically lies between the 20th and 40th year. However, there are also known cases with occurrence from infancy up to well after the 80th year. As in migraine, females are affected 2–3 times more often than males (Flachenecker et al., 2005).

While many symptoms such as paresis, paresthesias and numbness, ataxia, visual disturbances, neuro‐urological dysfunction, neuropsychological deficits, and fatigue often appear in the course of MS, headaches are not regarded as typical early MS symptoms or MS‐related symptoms (Möhrke, Kropp, & Zettl, 2013; Zettl, Stüve, & Patejdl, 2012). Till the 1990s relatively low prevalence rates for headaches in the course of MS were found ranging between 4% and 37.5% (Abb & Schaltenbrand, 1956; Bonduelle & Albaranes, 1962; Clifford & Trotter, 1984; Freedman & Gray, 1989; Poser, Presthus, & Horsda, 1966; Watkins & Espir, 1969), whereas higher prevalence rates of up to 64% were reported since 2000 (Boneschi et al., 2008; D’Amico et al., 2004; Kister et al., 2010; Möhrke et al., 2013; Nicoletti et al., 2008; Putzki et al., 2009; Vacca et al., 2007; Villani et al., 2008).

This high prevalence of headache raises the question whether it is really a comorbidity of two independent diseases or whether the headache could be a primary symptom of MS. Clinically and therapeutically this would be highly relevant, as the presence of headache alone would allow the diagnostic classification as clinically isolated syndrome (CIS) or early MS (Polman et al., 2011) instead of radiologically isolated syndrome (RIS) and could be helpful to assess disease activity (Lublin, 2014). RIS is defined by typical MS lesions found in magnetic resonance imaging (MRI), without the presence of clinical MS symptoms (Okuda et al., 2009).

Postmortem histological analyses of the brains in MS patients revealed the presence of lymphoid follicle‐like structures in the cerebral meninges resulting in meningeal inflammation as a possible pathophysiological explanation for the high prevalence of headache, especially migraine (Magliozzi et al., 2007). It is striking that these tertiary, in particular, B‐cell follicles were found in 41.4% of the patients with secondary progressive MS (SPMS) (Howell et al., 2011; Magliozzi et al., 2010). In addition, there is also a higher number of macrophages, T‐ and B cells in patients with SPMS. SPMS is marked by transition into a continuously progressive form of the disease without the initial relapsing‐remitting phenotype anymore associated with an increase in degeneration. An even higher degree of meningeal inflammation (and consecutively headache) is to be expected with patients in the early stage of the relapsing‐remitting MS (RRMS) or CIS as inflammation is typically predominant here. However, due to the low impairment and mortality in the early stage, postmortem analyses for these patients have not been performed.

Möhrke et al. (2013) reported that MS patients with headaches are younger, more likely female, and less severely affected in their motor functions than those without. The patient cohort consisted of patients with relapsing‐remitting as well as progressive course, but only three patients with CIS.

The aim of this study was to evaluate headache characteristics during the first clinical event when the initial diagnosis of a CIS or MS was made.

2. METHODS

In a prospective, multicenter study 50 consecutive patients with the initial diagnosis of CIS or MS and an occurrence of neurological symptoms within the last 6 months were recruited in the Department of Neurology of Martha‐Maria Hospital and in four private neurological practices in Halle, Germany. The current diagnostic criteria by McDonald (Polman et al., 2011) were met based on an extensive history, clinical examination, MRI of the CNS, and cerebrospinal fluid (CSF) at the time of the first clinical manifestation of neurological symptoms. Exclusion criteria were concomitant diseases known to cause secondary headaches (such as cerebral hemorrhage). There were no screening failures or drop outs.

All study participants underwent in the course of the diagnostic process a detailed and structured clinical interview about their case history and they were asked to complete a semistructured interview covering headache frequency, duration, character, localization, and the presence of accompanying symptoms within the last 4 weeks before hospitalization with help of the Rostock Headache Questionnaire (Rokoko), a validated tool to screen primary headaches (Müller et al., 2014). It allows classification of headaches into migraine with and without aura, tension‐type headache (TTH) and cluster headache. Concerning optic neuritis, we asked especially for pain localized in retro‐orbital, orbital or frontal region, or aggravation by eye movement, so we separated the symptoms from other forms of headache.

Afterward the participants underwent a clinical‐neurological investigation, including the evaluation of disease severity on the Expanded Disability Status Scale (EDSS) (Kurtzke, 1983). Then, a MRI of the central nervous system and a CSF analysis were done. In addition, visual and somatosensory‐evoked potentials were recorded as well as transcranial magnetic stimulation and we determined relevant antibodies for differential diagnostic (Figure ).

This study was approved by the ethics committee of the medical association Saxony‐Anhalt (no. 7/15).

3. RESULTS

Thirty‐nine women (78%) and 11 men (22%) were included. The mean age of the patients was 32.0 years (SD 9.4, min 18, max 54). The latency between the first onset of clinical symptoms to study inclusion amounted from 5 days to a maximum of 6 months. The mean EDSS value was to 1.9 (SD 1.6) (Table ).

Table 1

Sociodemographic and neurological parameters

	N ^a	[%]	Mean	SD
Patients	50
Gender
Male	11 (4)	22
Female	39 (8)	78
Age			32. 0	9.4
EDSS			1.9	1.6
Symptomatic
Monosymptomatic	24	48
Polysymptomatic	26	52
Symptoms^b
Headache	39	78
Paresthesia and numbness	30	60
Paresis	16	32
Optic neuritis	14	28
Brainstem, cerebellar symptoms	9	18
Neuro‐urological dysfunction	2	4
Dysarthria	2	4

Thirty‐nine of fifty patients (78%) reported headaches within the last 4 weeks. According to the criteria of the RoKoKo, seven patients (14%) suffered from TTH, five (10%) from migraine (three without aura, two with aura), 18 (36%) from migraine‐like headaches, and nine (18%) from unclassifiable headaches.

Twenty‐three patients (46%) reported recurrent headaches only, seven (14%) of permanent, and eight (16%) of both recurrent and permanent headaches. Most patients suffered from throbbing and pulsating headaches (25, 50%), 15 (30%) reported stabbing, and 14 (28%) dull and constrictive headaches (Table ).

Table 2

	N	[%]
Pain frequency
Recurrent	23	46
Permanent	7	14
Recurrent and permanent	8	16
Other than that	1	2
Pain character^a
Throbbing and pulsating	25	50
Stabbing	15	30
Dull and constrictive	14	28
Burning	3	6
Nagging	5	10
Duration
<1 hr	2	4
1–3 hr	13	26
4–72 hr	28	56
>72 hr	3	6
Headache medication
Never	21	42
1–4×/month	15	30
5–9×/month	5	10
>=10×/month	9	18
4 weeks after glucocorticosteroid therapy
Small improvement	11	28. 2
Substantial improvement	10	25.6
Completely remitted	8	20.5
Change in location and character	1	2.6
No change	9	23.1

Headaches lasted between 4 and 72 hr in 28 patients (56%). Two patients (4%) also reported having <1 hr of headaches, 13 patients (26%) between 1 and 3 hr and three patients (6%) longer than 72 hr. Eight patients (16%) even reported of longer than 14 days lasting headaches during the last 4 weeks.

Twenty‐one of fifty patients (42%) had taken no headache‐specific medication during the preceding 4 weeks. Fifteen patients (30%) had taken medication for 1–4 days, five (10%) for 5–9 days, and nine patients (18%) for 10 and more days during the last 4 weeks.

A total of 12 patients (24%) reported a positive family history for headaches.

Headaches were the most frequent neurological symptom at the time of the clinical manifestation of the inflammatory CNS disease (CIS, RRMS) (78% of patients).

Thirty patients (60%) suffered from paresthesia (“tingling”) and numbness, 16 (32%) had central paresis. In 14 patients (28%) the disease began with an optic neuritis, in nine (18%) with brainstem or cerebellar symptoms, in two patients (4%) with neuro‐urological dysfunction, and in two patients (4%) with a dysarthria.

All patients received a high‐dose intravenous glucocorticosteroid (GCS) treatment for 5 days with 1000 mg methylprednisolone per day. Four weeks after GCS therapy 11 of the 39 headache patients (28. 2%) reported a small improvement of headaches, 10 (25.6%) a substantial improvement, and in eight (20.5%) patients that the headaches remitted completely. Nine patients (23. 1%) reported no change after the GCS therapy and one patient (2. 6%) noted only a change in headache location and character.

4. DISCUSSION

Headache prevalence was as high as 78% in our group of patients and is therefore among the highest found in patients with CIS or MS. While in other studies, MS patients were examined regardless of their disease duration and course (Abb & Schaltenbrand, 1956; Bonduelle & Albaranes, 1962; Boneschi et al., 2008; Clifford & Trotter, 1984; D’Amico et al., 2004; Freedman & Gray, 1989; Kister et al., 2010; Möhrke et al., 2013; Nicoletti et al., 2008; Poser et al., 1966; Putzki et al., 2009; Vacca et al., 2007; Villani et al., 2008; Watkins & Espir, 1969), well‐characterized patients in the early stages of the disease (namely within the first 6 months after the first manifestation of clinical symptoms) were included in this study. In other studies the mean duration of MS ranged between 14 years (Vacca et al., 2007), respectively, 13.4 years (D’Amico et al., 2004) and 8.8 years (Villani et al., 2008). Compared to the already high 1‐year headache prevalence of 62.5% in the general German population (Straube et al., 2013), it was even higher in our selected population. In addition, it was the most frequent neurological symptom reported by patients, followed by paresis, paresthesia and hypesthesia, optic neuritis, and brainstem or cerebellar symptoms. These further symptoms were also found in other studies in the first manifestations of the disease (Poser, Raun, & Poser, 1982; Weinshenker et al., 1989).

The observed high prevalence of headaches, especially of a migraineous subtype, could be due to a shared pathophysiology. Migraine, which affects significantly more females than males (like MS), has been associated with meningeal inflammation resulting in nociceptive trigeminal activation (Levy, 2009). It has been suggested that inflammatory activity is highest early in the course of MS which would well explain a large overlap with especially migraineous headaches. It is tempting to speculate that headache could in fact be an early symptom of MS itself and not merely coincidental.

Interestingly, Granberg et al. found that in half of the patients with RIS, headaches were the reason for the MRI investigation leading to the incidental diagnosis of RIS (Granberg, Martola, Kristoffersen‐Wiberg, Aspelin, & Fredrikson, 2013). In two of three cases, a progression of MRI lesions can be observed during the next 2 to 5 years, while in the same period, one of three cases fulfill the criteria for “classical” CIS or MS (Granberg et al., 2013). Of great importance is the exact classification between RIS and CIS/RRMS, because studies show that the magnitude of the T2 lesions and signs of neurodegeneration do not differ from RIS patients to patients with early RRMS (Azevedo et al., 2015; De Stefano et al., 2011). These data suggest that if it were possible to define a MS‐typical headache, with the aid of other examinations, patients with these headaches and with typical MRI results would be classified as CIS or early MS instead of RIS and treated with an immunomodulatory therapy (Comi et al. , 2009; Kappos et al., 2006; Miller & Leary, 2009).

More than 50% of our CIS patients suffer from headaches which do not fulfill the formal diagnostic criteria of primary headaches. Most often, recurrent pain of pulsating‐throbbing character was reported lasting between 4 and 72 hr. It could be classified as probable migraine (36%) according to the ICHD‐III (Headache Classification Committee of the International Headache Society, 2013), because they fulfill three of four diagnostic criteria required for a formal diagnosis of migraine and at the same time do not fulfill the criteria of another primary headache. Five patients (10%) even fulfilled all diagnostic criteria of a migraine, so that almost half of all patients suffer from a migraine or a probable migraine; however, only seven (14%) suffer from TTH (test sensitivity/specificity of the RoKoKo of 0.87/0.51 for migraine without aura, 0.71/0.95 for migraine with aura and 0.57/0.93 for TTH). These results are comparable with other studies. In a work of Tabby, Majeed, Youngman, & Wilcox (2013), throbbing headaches were found in 52.9% patients as the most frequent form in 72 MS patients with headaches. D’Amico et al. (2004) found a substantial number of MS patients reported headaches that were classified as probable migraine, because they did not fulfill all diagnostic criteria of a migraine. These also occurred more frequently in patients with RRMS, while TTH was associated with the progressive course of the disease. The strongly differing findings of previous studies on migraine prevalence in MS patients between 19.8% and 82% (Nicoletti et al., 2008; Vacca et al., 2007) and TTH prevalence between 12.2% and 55.2% (D’Amico et al., 2004; Villani et al., 2008) appear to correlate with MS duration.

Pakpoor, Handel, Giovannoni, Dobson, & Ramagopalan (2012) found within the scope of a meta‐analysis that MS patients suffer from migraine more than twice as often as healthy controls. Other studies support a close co‐occurrence of both diseases: in a study of Kister, Munger, Herbert, & Ascherio (2012) patients with migraine had a 39‐fold higher risk of developing MS, while Kruit, van Bucehm, Launer, Terwindt, & Ferrari (2010) reported a correlation of migraine attack frequency with the number of white‐matter lesions. Moreover, it appeared that MS patients with migraine suffered from more relapses than MS patients without migraine (Elliot, 2007; Kister et al., 2010). Another striking similarity between MS and migraine is the high prevalence in young women and the protective effect of pregnancy and lactation. Also undulating courses, episodes with high disease activity over many years and intermittent phases of high disease activity are often observed in both disorders. This raises the question whether migraine headache observed in a large group of MS patients represents a symptomatic headache mimicking migraine or represents an activation of genuine migraine pathology with inflammatory changes as the trigger.

Interestingly, 29 of 39 patients (74.4%) noted an improvement of the headaches following steroid therapy after 4 weeks. Although some studies have questioned the efficacy of steroids in migraine (Fiesseler et al., 2011), there is substantial evidence that steroids interfere with CGRP release (Neeb, Hellen, Hoffmann, Dirnagl, & Reuter, 2016; Neeb et al. , 2015). In status migrainosus, high dose of GCS were effective additively (Rozen, 2002). Therefore, it would be interesting to examine whether patients experience a long‐term improvement of their headaches after short‐time therapy with GCS.

From a pathophysiological perspective, the meningeal inflammation described by Maggliozi et al. involving B‐cell and T‐cell activation in MS patients could also be the cause of headache manifestation. This would also explain why the prevalence of headaches is so high at the beginning of the disease.

Despite the intriguing findings, our study has some shortcomings. Headache characteristics were assessed with the Rokoko‐questionnaire only, which has been shown to have a high diagnostic accuracy (Kurtzke, 1983). However, a relatively large group of patients with headaches could not be allocated to either migraine or tension‐type headache. In a structured clinical interview carried out by a headache expert this could have had reached a higher sensitivity and specificity. In addition, a previous personal history of headaches was not assessed, so that we could not ascertain whether the reported headaches developed de novo in temporal relation to the neurological symptoms leading to the diagnosis of CIS or MS or whether they were just an exacerbation or reoccurrence of a preexisting primary headache. Also the emotional stress prior to the hospitalization could be a reason for exacerbation of migraine and so a potential bias.Due to the lack of an appropriate control group it is difficult to assess whether prevalence rates in our sample are indeed higher than in the general population. However, setting up a matched control group is problematic and would require a large prospective epidemiological study.

5. CONCLUSION

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. However, it is not regarded as MS‐related or typical symptom. If it were possible to define a MS‐typical headache, patients with these headaches and with MS‐typical MRI results would be classified as CIS or early MS instead of RIS and treated accordingly with an immunomodulatory therapy. This kind of MS‐typical headache seems to be very similar to migraine, because we often found recurrent pain of pulsating‐throbbing character, lasting between 4 and 72 hr, that does not fulfill the criteria of migraine. Separating these cases from “classical” migraine may help the results of studies, which could show strong differences between MS and migraine in MR morphology (Absinta et al., 2012). According to this it could be an important aim of future MR‐studies to work out differences in MR findings between MS patients with and without headache.

CONSENT FOR PUBLICATION

Not applicable.

AVAILABILITY OF DATA AND MATERIAL

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

DISCLOSURES

All authors declare that they have no competing interests.

AUTHORS’ CONTRIBUTIONS

Not applicable.

REFERENCES

Abb, L.
, &
Schaltenbrand, G.
(1956). Statistical study of the problem of multiple sclerosis. II. The clinical aspects of the disease. Deutsche Gesellschaft für Neurochirurgie, 174, 199–218. [PubMed] [Google Scholar]
Absinta, M.
,
Rocca, M. A.
,
Colombo, B.
,
Copetti, M.
,
De Feo, D.
,
Falini, A.
, …
Filippi, M.
(2012). Patients with migraine do not have MRI‐visible cortical lesions. Journal of Neurology, 259, 2695–2698. [PubMed] [Google Scholar]
Azevedo, C. J.
,
Overton, E.
,
Khadka, S.
,
Buckley, J.
,
Liu, S.
,
Sampat, M.
, …
Pelletier, D.
(2015). Early CNS neurodegeneration in radiologically isolated syndrome. Neurology Neuroimmunology & Neuroinflammation, 2(3), e102. [PMC free article] [PubMed] [Google Scholar]
Bonduelle, M.
, &
Albaranes, R.
(1962). Étude statistique de 145 case de sclérose en plaque. Seminars Hop Paris, 68, 3762–3773. [Google Scholar]
Boneschi, F. M.
,
Colombo, B.
,
Annovazzi, P.
,
Martinelli, V.
,
Bernasconi, L.
,
Solaro, C.
, &
Comi, G.
(2008). Lifetime and actual prevalence of pain and headache in multiple sclerosis. Multiple Sclerosis, 14, 514–521. [PubMed] [Google Scholar]
Browne, P.
,
Chandraratna, D.
,
Angood, C.
,
Tremlett, H.
,
Baker, C.
,
Taylor, B. V.
, &
Thompson, A. J.
(2014). Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity. Neurology, 83(11), 1022–1024. [PMC free article] [PubMed] [Google Scholar]
Clifford, D. B.
, &
Trotter, J. L.
(1984). Pain in Multiple Sclerosis. Archives of Neurology, 41, 1270–1272. [PubMed] [Google Scholar]
Comi, G.
,
Martinelli, V.
,
Rodegher, M.
,
Moiola, L.
,
Bajenaru, O.
,
Carra, A.
, …
Filippi, M.
(2009). Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (precise study): A randomised, double‐blind, placebo‐controlled trial. Lancet, 374, 1503–1511. [PubMed] [Google Scholar]
D’Amico, D.
,
La Mantia, L.
,
Rigamonti, A.
,
Usai, S.
,
Mascoli, N.
,
Milanese, C.
, &
Bussone, G.
(2004). Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia, 24, 980–984. [PubMed] [Google Scholar]
De Stefano, N.
,
Stromillo, M. L.
,
Rossi, F.
,
Battaglini, M.
,
Giorgio, A.
,
Portaccio, E.
, …
Amato, M. P.
(2011). Improving the characterization of radiologically isolated syndrome suggestive of multiple sclerosis. PLoS ONE, 6, e19452
https://doi.org/10.1371/journal.pone.0019452
[PMC free article] [PubMed] [Google Scholar]
Elliot, D. G.
(2007). Migraine in Multiple Sclerosis. International Review of Neurobiology, 79, 281–302. [PubMed] [Google Scholar]
Fiesseler, F. W.
,
Shih, R.
,
Szucs, P.
,
Silverman, M. E.
,
Eskin, B.
,
Clement, M.
, …
Majlesi, N.
(2011). Steroids for migraine headaches: A randomized double‐blind, two‐armed, placebo‐controlled trial. Journal of Emergency Medicine, 40(4), 463–468. [PubMed] [Google Scholar]
Flachenecker, P.
,
Stuke, K.
,
Elias, W.
,
Freidel, M.
,
Haas, J.
,
Pitschnau‐Michel, D.
, …
Rieckmann, P.
(2008). Multiple sclerosis registry in Germany: Results of the extension phase 2005/2006. Deutsches Ärzteblatt International, 105(7), 113–119. [PMC free article] [PubMed] [Google Scholar]
Flachenecker, P.
,
Zettl, U.
,
Götze, U.
,
Haas, J.
,
Schimrigk, S.
,
Elias, W.
, …
Rieckmann, P.
(2005). MS registry in Germany–design and first results of the pilot phase. Der Nervenarzt, 76(8), 967–975. [PubMed] [Google Scholar]
Freedman, M. S.
, &
Gray, T. A.
(1989). Vascular headache: A presenting symptom of multiple sclerosis. Canadian Journal of Neurological Sciences, 16, 63–66. [PubMed] [Google Scholar]
Granberg, T.
,
Martola, J.
,
Kristoffersen‐Wiberg, M.
,
Aspelin, P.
, &
Fredrikson, S.
(2013). Radiologically isolated syndrome–incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review. Multiple Sclerosis, 19(3), 271–280. [PubMed] [Google Scholar]
Headache Classification Committee of the International Headache Society
(2013). The international classification of headache disorders, 3rd edition. Cephalalgia, 33, 629–808. [PubMed] [Google Scholar]
Howell, O.
,
Reeves, C.
,
Nicholas, R.
,
Carassiti, D.
,
Radotra, B.
,
Gentleman, S.
, …
Reynolds, R.
(2011). Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain, 134, 2755–2771. [PubMed] [Google Scholar]
Kappos, L.
,
Polman, C. H.
,
Freedman, M. S.
,
Edan, G.
,
Hartung, H. P.
,
Miller, D. H.
, …
Sandbrink, R.
(2006). Treatment with interferon beta‐1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology, 67(7), 1242–1249. [PubMed] [Google Scholar]
Kister, I.
,
Caminero, A. B.
,
Monteith, T. S.
,
Soliman, A.
,
Bacon, T. E.
,
Bacon, J. H.
, …
Lipton, R. B.
(2010). Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. Journal of Headache and Pain, 11(5), 417–425. [PMC free article] [PubMed] [Google Scholar]
Kister, I.
,
Munger, K. L.
,
Herbert, J.
, &
Ascherio, A.
(2012). Increased risk of multiple sclerosis among women with migraine in the nurses’ health study II. Multiple Sclerosis, 18(1), 90–97. [PMC free article] [PubMed] [Google Scholar]
Kruit, M. C.
,
van Bucehm, M. A.
,
Launer, L. J.
,
Terwindt, G. M.
, &
Ferrari, M. D.
(2010). Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: The population‐based MRI CAMERA study. Cephalalgia, 30, 129–136. [PMC free article] [PubMed] [Google Scholar]
Kurtzke, J. F.
(1983). Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology, 33(11), 1444–1452. [PubMed] [Google Scholar]
Levy, D.
(2009). Migraine pain, meningeal inflammation, and mast cells. Current Pain and Headache Reports, 13(3), 237–240. [PubMed] [Google Scholar]
Lublin, F. D.
(2014). New multiple sclerosis phenotypic classification. European Neurology, 72(Suppl 1), 1–5. https://doi.org/10.1159/000367614
[PubMed] [Google Scholar]
Magliozzi, R.
,
Howell, O.
,
Reeves, C.
,
Roncaroli, F.
,
Nicholas, R.
,
Serafini, B.
, …
Reynolds, R.
(2010). A Gradient of neuronal loss and meningeal inflammation in multiple sclerosis. Annals of Neurology, 68(4), 477–493. [PubMed] [Google Scholar]
Magliozzi, R.
,
Howell, O.
,
Vora, A.
,
Serafini, B.
,
Nicholas, R.
,
Puopolo, M.
, …
Aloisi, F.
(2007). Meningeal B‐cell follicles in secondary progressive multiple sclerosis associate with early onset of disease and severe cortical pathology. Brain, 130(4), 1089–1104. [PubMed] [Google Scholar]
Miller, D. H.
, &
Leary, S. M.
(2009). Treatment of clinically isolated syndrome: To be PreCISe. Lancet, 374, 1475–1476. [PubMed] [Google Scholar]
Möhrke, J.
,
Kropp, P.
, &
Zettl, U. K.
(2013). Headaches in multiple sclerosis patients might imply an inflammatorial process. PLoS ONE, 8, e69570
https://doi.org/10.1371/journal.pone.0069570
[PMC free article] [PubMed] [Google Scholar]
Müller, B.
,
Baum, A.
,
Holzhausen, M.
,
Grittner, U.
,
Hilgendorf, I.
,
Martus, P.
, …
Kropp, P.
(2014). The Rostock Headache Questionnaire (“Rokoko”)–validation of a tool to screen and to qualify primary headaches. Fortschritte der Neurologie‐Psychiatrie, 82(3), 145–148. [PubMed] [Google Scholar]
Neeb, L.
,
Anders, L.
,
Euskirchen, P.
,
Hoffmann, J.
,
Israel, H.
, &
Reuter, U.
(2015). Corticosteroids alter CGRP and melatonin release in cluster headache episodes. Cephalalgia, 35(4), 317–326. [PubMed] [Google Scholar]
Neeb, L.
,
Hellen, P.
,
Hoffmann, J.
,
Dirnagl, U.
, &
Reuter, U.
(2016). prednisolone blocks interleukin 1 beta induced calcitonin gene related peptide release in trigeminal ganglia cells. Journal of Headache and Pain, 17(1), 19. [PMC free article] [PubMed] [Google Scholar]
Nicoletti, A.
,
Patti, F.
,
Lo Fermo, S.
,
Liberto, A.
,
Castiglione, A.
,
Laisa, P.
, …
Zappia, M.
(2008). Headache and multiple sclerosis: A population‐based case–control study in Catania, Sicily. Cephalalgia, 28, 1163–1169. [PubMed] [Google Scholar]
Okuda, D. T.
,
Mowry, E. M.
,
Beheshtian, A.
,
Waubant, E.
,
Baranzini, S. E.
,
Goodin, D. S.
, …
Pelletier, D.
(2009). Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome. Neurology, 72, 800–805. [PubMed] [Google Scholar]
Pakpoor, J.
,
Handel, A. E.
,
Giovannoni, G.
,
Dobson, R.
, &
Ramagopalan, S. V.
(2012). Meta‐analysis of the relationship between multiple sclerosis and migraine. PLoS ONE, 7, e45295
https://doi.org/10.1371/annotation/274e5ef1-79aa-48f7-af62-0594d5c1354e
[PMC free article] [PubMed] [Google Scholar]
Polman, C. H.
,
Reingold, S. C.
,
Banwell, B.
,
Clanet, M.
,
Cohen, J. A.
,
Filippi, M.
, …
Wolinsky, J. S.
(2011). Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology, 69(2), 292–302. [PMC free article] [PubMed] [Google Scholar]
Poser, C. M.
,
Presthus, J.
, &
Horsda, O.
(1966). Clinical characteristics of autopsy‐proved multiple sclerosis. Neurology, 16, 791–798. [Google Scholar]
Poser, S.
,
Raun, N. E.
, &
Poser, W.
(1982). Age at onset, initial symptomatology and the course of multiple sclerosis. Acta Neurologica Scandinavica, 66(3), 355–362. [PubMed] [Google Scholar]
Putzki, N.
,
Pfriem, A.
,
Limmroth, V.
,
Yaldizli, O.
,
Tettenborn, B.
,
Diener, H. C.
, &
Katsarava, Z.
(2009). Prevalence of migraine, tension‐type headache and trigeminal neuralgia in multiple sclerosis. European Journal of Neurology, 16, 262–267. [PubMed] [Google Scholar]
Rozen, T. D.
(2002). Migraine headache: Immunosuppressant therapy. Current Treatment Options in Neurology, 4(5), 395–401. [PubMed] [Google Scholar]
Straube, A.
,
Aicher, B.
,
Förderreuther, S.
,
Eggert, T.
,
Köppel, J.
,
Möller, S.
, …
Haag, G.
(2013). Period prevalence of self‐reported headache in the general population in Germany from 1995‐2005 and 2009: Results from annual nationwide population‐based cross‐sectional surveys. Journal of Headache and Pain, 14, 11. [PMC free article] [PubMed] [Google Scholar]
Tabby, D.
,
Majeed, M. H.
,
Youngman, B.
, &
Wilcox, J.
(2013). Headache in multiple sclerosis. International Journal of Care And Caring, 15, 73–80. [Google Scholar]
Vacca, G.
,
Marano, E.
,
Brescia Morra, V.
,
Lanzillo, R.
,
De Vito, M.
,
Parente, E.
, &
Orefice, G.
(2007). Multiple sclerosis and headache co‐morbidity. A case‐control study. Neurology Science, 28, 133–135. [PubMed] [Google Scholar]
Villani, V.
,
Prosperini, L.
,
Ciuffoli, A.
,
Pizzolato, R.
,
Salvetti, M.
,
Pozzilli, C.
, &
Sette, G.
(2008). Primary headache and multiple sclerosis: Preliminary results of a prospective study. Neurology Science, 29, S146–S148. [PubMed] [Google Scholar]
Watkins, M. S.
, &
Espir, M.
(1969). Migraine and multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry, 32, 35–37. [PMC free article] [PubMed] [Google Scholar]
Weinshenker, B. G.
,
Bass, B.
,
Rice, G. P.
,
Noseworthy, J.
,
Carriere, W.
,
Baskerville, J.
, &
Ebers, G. C.
(1989). The natural history of multiple sclerosis: A geographically based study. I. Clinical course and disability. Brain, 112(1), 133–146. [PubMed] [Google Scholar]
Zettl, U. K.
,
Stüve, O.
, &
Patejdl, R.
(2012). Immune‐mediated CNS diseases: A review on nosological classification and clinical features. Autoimmunity Reviews, 11(3), 167–173. [PubMed] [Google Scholar]

Headaches in MS

Summary

This research found that headaches are more common in people with MS than in the general population. It looked in particular at migraine, tension type headache and cluster headaches.

The researchers compared the characteristics of those people with MS who experienced headaches with those who didn’t. People who experienced headaches were significantly younger, much more likely to be women and were less impaired in their motor function (the ability to use and control muscles and movements).

People with relapsing remitting MS occurred more often in the headache group whereas those with secondary progressive MS were more often in the non-headache group. The probability of having headaches was also dependent on the medication being taken. In particular, those on glatiramer acetate (Copaxone) were five times more likely to experience headaches.

Background

Headaches come in a number of different forms. This study focused migraine, tension type headache (TTH) and cluster headaches.

Migraine is a pulsating, often one-sided headache which lasts between 4 and 72 hours and is common in the general population. Estimates vary but it occurs in around one in seven to one ten individuals. About one third of these have migraine with aura which is a warning sign before the migraine begins. This advance warning can be visual problems, including flashing lights, and stiffness in the neck, shoulders or limbs.

Tension type headache feels like a continual nagging-pressing pain and occurs in about one third to two thirds of the general population at some time in their life.

Cluster headaches are described as a sharp, sudden, one sided pain which is severe and associated with eye pain. It is much less common in the general population as it occurs in only about four to six people in every thousand.

This study aimed to establish how common these types of headache were in people with MS and what factors made it more likely that someone would experience headaches.

How this study was carried out

125 women and 55 men with MS in Germany were interviewed. None of them had other conditions, such as a brain tumour, which might cause headaches.

Clinical data about their MS, including when their MS began, their EDSS score (a measure of disability) and any medication taken, were recorded. Any headaches were classified according to international guidelines into migraine with and without aura, tension-type headache, or cluster-headache.

General health was assessed using the Short Form 36 Health Survey (SF36) which looks at eight dimensions including physical function, pain, general health, vitality, and social functioning. The Beck’s depression inventory (BDI) was used to assess for depression.

The average age of the group was 44 and the average time since the onset of MS was 12 years. Almost half (48%) had relapsing remitting MS, over a third (37%) had secondary progressive MS and just over one in eight (13%) had primary progressive MS. Just three (1.7%) had clinically isolated syndrome.

Members of the group were receiving a wide range of disease modifying treatments with only 12 (7%) not receiving any during the time frame of the study. The average EDSS score was 3.6 although it varied widely.

What was found

98 of the 180 people in the study (55%) reported having a headache in the previous four weeks. Out of these, 16 had experienced migraine (2 without aura and 14 with aura) and 23 had experienced a tension type headache but no-one had suffered a cluster headache. The other 59 people were categorised as having suffered an unclassified headache as the characteristics of their headache did not fit with the three categories under study.

The researchers compared the characteristics of those who experienced headaches with those who didn’t. People who experienced headaches were significantly younger, much more likely to be women and less impaired in their motor function (the ability to use and control muscles and movements).

People with relapsing remitting MS occurred more often in the headache group whereas those with secondary progressive MS were more often in the non-headache group.

The number of people with headaches varied according to some of the medications they took. Half (51%) of the non-headache group had been treated with corticosteroids but only a quarter (28%) of the headache group had received this treatment. Those with headache were five times more likely to be treated with glatiramer acetate or immunoglobulins.

People without headaches also suffered from less bodily pain and scored better in social functioning but were much more limited physically. Conversely, the lower a person’s EDSS score, corresponding to a lower overall level of disability, the more likely they were to suffer from migraine. Those who scored highly on bodily pain were more likely to suffer tension type headaches.

What does it mean?

The authors concluded that headaches occur more often in people with MS than in the general population. Headaches occurred more often in younger people with MS and in people on certain disease modifying treatments.

They suggest that headaches may be a more significant part of MS than previously realised.

More about headaches

In 2012, another study was published about migraine in MS. It pooled the results of eight previous studies and found that migraine was twice as common in people with MS than in the general population.

You can read more about migraine, cluster headaches and tension type headaches on the NHS Choices web site. There is also information on other causes of headache.

Headache is a known and common side effect for the disease modifying treatment glatiramer acetate.

Keeping a diary

If you experience headaches, it can be useful to keep a diary of symptoms and when they occur over two to three months. The Migraine Trust offers tips for keeping a diary or you can print off a simplified version (PDF) to fill in by hand .

It can be helpful to record information on:

Severity of the pain
Warning symptoms
If there are other symptoms (such as being sick or having vision problems)
How long the attacks last
Where the pain is
Whether the pain is throbbing or piercing

Also, to note down as many aspects of daily life as possible, such as:

What and when you eat
Your medication
Vitamins or health products
Any exercise you take
Other factors such as the weather
For women, the stage of their monthly cycle.

The diary can help a doctor make the correct diagnosis and identify any triggers for your headaches. It can also help in identifying the warning signs of an attack and whether any medication you are taking for your headaches is working.

Research by topic areas…

Multiple sclerosis presenting initially with a worsening of migraine symptoms | The Journal of Headache and Pain

Here, we report the case of a patient who showed worsening migraine as the initial presenting symptom of MS. MS was diagnosed according to the McDonald criteria (2010 revision). This patient had one episode of MS attack and exhibited the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions on the first brain MRI scan. The McDonald criteria for category III were established.

Patients with MS have a high prevalence of headache; headache occurs more commonly in patients with MS (27%) than in matched controls (12%) [7]. D’Amico and colleagues reported a 57. 7% lifetime prevalence of headache in 137 patients with clinically definite MS [8]. However, it is unclear whether headache is a symptom of the onset of MS. Kurtzke et al. [9] considered headache as a subtle symptom of MS onset, with a variable frequency of 1.6–28.5%. This variation in frequency might be explained by differences in study design and patient inclusion criteria. Ophthalmoplegic migraine-like headache [10], complicated migraine [11], short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) [12], and cluster tic syndrome [13] have also been reported in single MS cases. Fragoso and Brooks [14] described a single case and Yetimalar et al. [15] reported the cases of two young women with migraine onset as the only symptom of the first episode of MS. These cases were different from our patient because they had no history of migraine without aura.

To our knowledge, there is no description in the literature of patients presenting with worsening migraine symptoms without neurological signs as the first episode of MS. When the initial symptoms of MS are worsening migraines and changes in headache patterns, they may be discounted as a recurrent event and ignored. Our study suggest that it is important to consider the possibility of MS in patients with worsening migraine symptoms accompanied by episodes of focal deficit and to follow-up these patients regularly.

Tortorella et al. found that patients with migraine had supratentorial lesions chiefly located in the frontal lobes and periventricular white matter and noted no difference in the number of supratentorial lesions between patients with migraine with or without aura [16]. In our case, the first brain MRI scan showed signs that were unlike the migraine lesions at the locations mentioned above, and there was damage to the periventricular and infratentorial PAG regions.

Many factors can trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger [17]. In our case, none of the above-mentioned factors was found. We hypothesize that stress causes inflammation in general, and particularly in MS, because stress-related neuropeptides activate the excretion of inflammatory molecules by microglia and mast cells [18]. Although no obvious stress was observed in our case, a hidden stress may have caused the acute MS attacks. As observed in our case, MS may be considered as one of the differential diagnoses of acute-migraine-like episodes.

The PAG modulates pain via the descending system and exerts an antinociceptive effect to the peripheral afferent system. Gee et al. showed that patients having MS with a plaque located within the PAG region displayed a four-fold increase in migraine-like headaches [19]. In our experience, common migraine attacks generally require no further imaging examinations. However, in our case, worsening migraine followed by an episode of focal neurological deficit indicated that we should look for any secondary causes of the symptoms. The involvement of the PAG region may explain why this case presented initially with worsening migraine headache without clinical response. The patient initially refused treatment when MS was diagnosed because of symptom relief; however, unfortunately, the symptoms recurred two months later. Although there is no cure for MS, the diagnosis of the disease and early initiation of an appropriate treatment are the best strategies to prevent severe neurological deficits.

Moreover, the more frequent administration of the IFNb preparation, as performed here, seems better than the administration of IFNb-1a just once a week [20, 21]. In fact, in a previous study worsening of pre-existing headaches or de novo headaches were found only in patients with MS who received interferon therapy, and not in those who received other disease-modifying therapies [22]. Compared to natalizumab (NTZ), IFNb might cause a continued increase in the frequency and severity of migraine in cases of MS [23]. However, NTZ was approved by the US Food and Drug Administration as a second-line monotherapy for patients with MS who exhibit no response to other immunomodulating drugs [24]. In addition, glatiramer acetate is not available currently in our hospital. In our case, the patient receives a subcutaneous injection of interferon beta-1a thrice a week after well discussion with the patient.

Are headaches more common during a relapse?

Summary

Headaches are more common in people with MS. This study investigated if headaches were more likely to occur during a relapse than remission.

People with relapsing remitting MS and people without a neurological condition were questioned about if they had experienced a headache in the previous seven days and if so what were the characteristics of the headache. The people with MS were questioned during a relapse and the again three months after they had recovered.

It was found that headaches were more common during a relapse, particularly migraines. However headaches were more also more common in people with MS during remission too, when compared to the general population.

Background

Previous research has shown that headaches are more common in people with MS than the general population, as has been covered in previous research updates on headaches and migraines.

This study investigated if headaches were more common during a relapse and what type of headaches these were.

How this study was carried out

57 people with relapsing remitting MS and 57 people without a neurological condition (control group) in Iran took part and completed the study.

The people with MS were recruited to the study when they attended a hospital clinic as they were having a relapse. Members of the control group were recruited from the friends and family members that were accompanying a person with MS to the clinic.

Participants were questioned about if they experienced headaches over the previous seven days. The headaches were diagnosed and classified against the types in the International Classification of Headache Disorders.

For those that experienced headaches, information about the characteristics of their headaches were collected including:

what type they were (migraine, tension headache or secondary headache – that is one which is the symptom of something else such as a hangover or caused by another health condition such as a sinus or ear infection)
the severity of the headaches on a scale of 1 (lowest severity) to 10 (very severe)
the quality of the pain (compressing, pulsating or stabbing)
the location of the headache in the head and if this was in one location or could be felt in several locations
the presence of other headache symptoms, in addition to pain (aversion to light, aversion to sounds, nausea, vomiting)

For the participants with MS, the researchers also collected information about their MS, current treatment with disease modifying drugs and the characteristics of the relapse they were experiencing. These participants were followed up three months after their relapse and asked the same questions about headaches.

What was found

The study found:

Nearly half (45.6%) of the people with MS having a relapse also experienced a headache, compared to over a third (38.6%) of people when they were in remission and just under a third (27.7%) of people without a neurological condition experienced a headache.
Headaches were more common in people with MS during a relapse.
The most common type of headache to experience during a relapse was migraine, followed by tension headache.
Headaches experienced during a relapse more reported to be severe and described as compressing.
The most common headaches experienced during remission were also migraines but these were described as being less severe.
People who had been diagnosed with MS in the last three years were more likely to experience a headache during their relapse than people who had been diagnosed for longer.
No relationship was found between headache and the type of relapse (so site of the MS lesion).

What does it mean?

The study shows that headaches, and particularly migraines, can be more common in people with MS during a relapse. However headaches have already been found by previous research to be more common in people with MS and this is reflected in the current study by the number of people that reported headaches when they were also in remission, compared to people without neurological conditions.

However the design of this study means that although it has shown that headaches are more common during a relapse and also more likely to occur in people who have had MS for a shorter period of time it cannot explain why. The authors conclude that headache may be a warning sign that a relapse is coming and early treatment could potentially prevent a relapse developing further. However further research would be needed to investigate the link in more detail, as headaches are also highly likely to occur during remission too.

Togha M, Abbasi Khoshsirat N, Moghadasi AN, et al.
Headache in relapse and remission phases of multiple sclerosis: a case-control study.
Iran J Neurol. 2016 Jan 5;15(1):1-8.
Abstract
Read the full text of this paper

More about headaches

Two previous studies covered in research update have shown that headaches and migraines are more common in people with MS than in the general population. You can read more about migraine, cluster headaches and tension type headaches on the NHS Choices web site. There is also information on other causes of headache.

Headache is a known and common side effect for some of the disease modifying drugs including Copaxone and Tysabri.

Headache can be just one type pain that people with MS may experience. If you are experiencing frequent headaches or other pain you could speak to your MS specialist team or GP. They may be able to help directly or may refer you to specialist support.

You can read more about pain in MS and the treatments that can help in the A-Z of MS.

Research by topic areas…

Multiple sclerosis – Symptoms – NHS

Multiple sclerosis (MS) can cause a wide range of symptoms and affect any part of the body. Each person with the condition is affected differently.

The symptoms are unpredictable. Some people’s symptoms develop and worsen steadily over time, while for others they come and go.

Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.

Some of the most common symptoms include:

Most people with MS only have a few of these symptoms.

See your GP if you’re worried you might have early signs of MS. The symptoms can be similar to several other conditions, so they’re not necessarily caused by MS.

Fatigue

Feeling fatigued is one of the most common and troublesome symptoms of MS.

It’s often described as an overwhelming sense of exhaustion that means it’s a struggle to carry out even the simplest activities.

Fatigue can significantly interfere with your daily activities and tends to get worse towards the end of each day, in hot weather, after exercising, or during illness.

Vision problems

In around 1 in 4 cases of MS, the first noticeable symptom is a problem with one of your eyes (optic neuritis).

You may experience:

some temporary loss of vision in the affected eye, usually lasting for days to weeks
colour blindness
eye pain, which is usually worse when moving the eye
flashes of light when moving the eye

Other problems that can occur in the eyes include:

double vision
involuntary eye movements, which can make it seem as though stationary objects are jumping around

Occasionally, both of your eyes may be affected.

Abnormal sensations

Abnormal sensations can be a common initial symptom of MS.

This often takes the form of numbness or tingling in different parts of your body, such as the arms, legs or trunk, which typically spreads out over a few days.

Muscle spasms, stiffness and weakness

MS can cause your muscles to:

contract tightly and painfully (spasm)
become stiff and resistant to movement (spasticity)
feel weak

Mobility problems

MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity.

You may experience:

clumsiness
difficulty with balance and co-ordination (ataxia)
shaking of the limbs (tremor)
dizziness and vertigo, which can make it feel as though everything around you is spinning

Pain

Some people with MS experience pain, which can take 2 forms.

Pain caused by MS itself (neuropathic pain)

This is pain caused by damage to the nervous system.

It may include:

stabbing pains in the face
a variety of sensations in the trunk and limbs, including feelings of burning, pins and needles, hugging or squeezing

Muscle spasms can sometimes be painful.

Musculoskeletal pain

Back, neck and joint pain can be indirectly caused by MS, particularly for people who have problems walking or moving around that puts pressure on their lower back or hips.

Problems with thinking, learning and planning

Some people with MS have problems with thinking, learning and planning, known as cognitive dysfunction.

This can include:

problems learning and remembering new things – long-term memory is usually unaffected
slowness in processing lots of information or multitasking
a shortened attention span
getting stuck on words
problems with understanding and processing visual information, such as reading a map
difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp how to do it
problems with reasoning, such as mathematical laws or solving puzzles

But many of these problems aren’t specific to MS and can be caused by a wide range of other conditions, including depression and anxiety, or even some medicines.

Mental health issues

Many people with MS experience periods of depression. It’s unclear whether this is directly caused by MS or the result of the stress of having to live with a long-term condition, or both.

Anxiety can also be a problem for people with MS, possibly because of the unpredictable nature of the condition.

In rare cases, people with MS can experience rapid and severe mood swings, suddenly bursting into tears, laughing, or shouting angrily for no apparent reason.

Sexual problems

MS can have an effect on sexual function.

Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction).

They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.

For women, problems include difficulty reaching orgasm, as well as decreased vaginal lubrication and sensation.

Both men and women with MS may find they’re less interested in sex than they were before.

This could be directly related to MS, or it could be the result of living with the condition.

Bladder problems

Bladder problems are common in MS.

They may include:

having to pee more frequently
having a sudden, urgent need to pee, which can lead to unintentionally passing urine (urge incontinence)
difficulty emptying the bladder completely
having to get up frequently during the night to pee
recurrent urinary tract infections (UTIs)

These problems can also have a range of causes other than MS.

Bowel problems

Many people with MS also have problems with their bowel function.

Constipation is the most common problem. You may find passing stools difficult and pass them much less frequently than normal.

Bowel incontinence is less common, but is often linked to constipation.

If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of your bottom.

Again, some of these problems aren’t specific to MS and can even be the result of medicines, such as medicines prescribed for pain.

Speech and swallowing difficulties

Some people with MS experience difficulty chewing or swallowing (dysphagia) at some point.

Speech may also become slurred, or difficult to understand (dysarthria).

Page last reviewed: 20 December 2018
Next review due: 20 December 2021

MS Pain | Multiple Sclerosis

Pain is a common symptom in MS, with up to two-thirds of people with MS reporting pain in worldwide studies. Those who experience pain may find it affects their daily life activities, such as work and recreation, and their mood and enjoyment of life.

Why does pain occur in MS and what are the common types?

Steady and achy types of pain in MS may be a result of muscles become fatigued and stretched when they are used to compensate for muscles that have been weakened by MS. People with MS may also experience more stabbing type pain which results from faulty nerve signals emanating from the nerves due to MS lesions in the brain and spinal cord.

The most common pain syndromes experienced by people with MS include:

headache (seen more in MS than the general population)
continuous burning pain in the extremities
back pain
painful tonic spasms (a cramping, pulling pain)

Experts usually describe pain caused by MS as musculoskeletal, paroxysmal or chronic neurogenic.

Musculoskeletal pain can be due to muscular weakness, spasticity and imbalance. It is most often seen in the hips, legs and arms and particularly when muscles, tendons and ligaments remain immobile for some time. Back pain may occur due to improper seating or incorrect posture while walking. Contractures associated with weakness and spasticity can be painful. Muscular spasms or cramps (called flex or spasms) can be severe and discomfiting. Leg spasms, for example, often occur during sleep.

Paroxysmal pains are seen in between five and ten per cent of people with MS. The most characteristic is the facial pain of trigeminal neuralgia, which usually responds to anticonvulsants such as carbamazepine, oxcarbazepine and lamotrigine.

Lhermittes is indicated by a stabbing, electric-shock-like sensation running from the back of the head down the spine brought on by bending the neck forward. Medication is of little use because this pain is instantaneous and brief, but anticonvulsants may be used to prevent the pain, or a soft collar to limit neck flexion.

Neurogenic pain is the most common and distressing of the pain syndromes in MS. This pain is described as constant, boring, burning or tingling intensely. It often occurs in the legs.

Paraesthesia types include pins and needles, tingling, shivering, burning pains, feelings of pressure, and areas of skin with heightened sensitivity to touch. The pains associated with these can be aching, throbbing, stabbing, shooting, gnawing, tingling, tightness and numbness.

Dysesthesia types include burning, aching or girdling around the body. These are neurologic in origin and are sometimes treated with antidepressants.

Optic Neuritis (ON) is a common first symptom of MS. Pain commonly occurs or is made worse with eye movement. The pain with ON usually resolves in between seven and ten days.

Treatment of pain in MS

Exercise and physical therapy may help to decrease spasticity and soreness of muscles. Regular stretching exercises can help flexorspasms. Relaxation techniques such as progressive relaxation, meditation and deep breathing can contribute to the management of chronic pain.

Other techniques which may relieve pain include massage, ultrasound, chiropractic treatments, hydrotherapy, acupuncture, transcutaneous nerve stimulation (TENS), moist heat and ice.

Pain from damage to the nerves in the central nervous system in MS is normally not relieved by the usual analgesics (such as aspirin). Drugs that treat seizures (like carbamazepine) and antidepressants (such as amitriptyline) are often effective in these cases. Treatment for spasms can include baclofen, tizanidine and ibuprofen.

Conclusion

Pain is MS is a hidden symptom, but one which can be persistent. Pain can cause long-term distress and impact severely on people’s quality of life. Self-help may play an important role in pain control; people who stay active and maintain positive attitudes seem more able to reduce the impact of pain on their quality of life.

Download the MS in focus magazine (you will need Acrobat Reader to view these files):

Aversa, Italy, 03/2012. Like many people with MS, Stefania Salzillo finds it difficult to cope with the daily injections of Interferon-b. Her boyfriend, Ernesto Lodice, helps out providing both practical and emotional support. But access to medication was relatively quick: she received her first prescription within two months of being diagnosed. The cost of DMDs in Italy is 100% covered by the national health plan. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.

Minsk, Belarus, 10/2011. Alena Kleshchanka (51) has spent most of the past seven years organising her days around Nicolai’s needs. Blind and virtually paralysed from the neck down, Nicolai is mentally sharp. While the physical burden of care is heavy for Alena, the couple continue to share a loving relationship. Credit: Walter Astrada. Published on this website by kind permission of the European Multiple Sclerosis Platform.

90,000 Headache – migraine and more: why the head hurts and what to do about it

Headache – migraine and not only: why the head hurts and what to do about it

Headache is probably one of the most common human pain sensations, both in childhood and in adults.

And it is not for nothing that a person with a headache is called a “medical orphan”.

“He goes from an ophthalmologist to an otorhinolaryngologist, neuropathologist, dentist, orthopedist, chiropractor.He is prescribed a lot of tests and a huge amount of drugs, and in the end he is left alone with his headache … “

Headache (cephalalgia) is the most common complaint that a patient presents when visiting a doctor. And, unfortunately, he is not always able to get adequate medical care that completely relieves him of these painful sensations.

The complexity of the problem of headache treatment lies primarily in its pronounced etiopathogenetic heterogeneity.In other words, many reasons can lead to the formation of pain syndrome , and its development is carried out in different ways and is mediated by different mechanisms.

Changes in various structures (bones, blood vessels, brain, spine, teeth, nerves, etc.) are accompanied by the same type of sensation called headache.

Feelings can vary in intensity, localization, frequency, but in general they significantly worsen the quality of life and in most cases require medical correction.

Relatively rarely, the causes of headache are organic brain lesions (tumors, cysts, abscesses, inflammatory lesions of the meninges, etc.) , in which it is necessary to use invasive methods of treatment.

In all other situations, it is possible to achieve relief (cessation) of headache or a significant decrease in the frequency of attacks and (or) their intensity in a conservative way using a complex of medications and additional methods of treatment (physiotherapy, exercise therapy, massage, psychotherapeutic correction, etc.). .

But in order for the treatment to be successful , first of all you need to understand why your head hurts specifically. These are not general words, since it is on this understanding that the approach to therapy is built. To ignore this means to continue tormenting and scolding everyone around. In that , that You are still experiencing this pain, there is also your fault!

Naturally, arguments of some, reducing to that “everyone hurts” , “age, what do you want” and “this is not cured at all” do not stand up to criticism and cannot be taken as serious.

ANY HEADACHE CAN AND MUST BE TREATED

The reasons for the development of headache can be divided into several groups:

1. Inflammatory , not related to damage to the central and peripheral nervous systems – reflected headaches (with inflammatory processes of the paranasal sinuses and forehead – sinusitis, frontal sinusitis, inflammation of the teeth, gums, bone structures of the upper and the lower jaw, inflammation of the ear structures – otitis media, inflammation of the salivary, lacrimal, thyroid glands, structures of the eyeball).

With all these processes headache is a complication of the main process and is completely stopped when it is cured . Painful sensations in the head are always accompanied by similar sensations in the inflammatory-altered organ or tissue. With the transition of an acute inflammatory process into a chronic stage, only cephalgic syndrome (i.e. headache) often remains.

2. Inflammatory associated with damage to the structures of the central and peripheral nervous systems (acute lesions of the nerve trunks – neuritis, neuralgia, chronic degenerative-inflammatory changes in the nerve trunks – neuropathies, lesions of the membranes of the brain – meningitis, arachnoiditis, damage to the brain substance brain – encephalitis, meningoencephalitis, abscesses).In these processes headache is one of the syndromes of severe illness and accompanies a complex of objective neurological symptoms. The mechanism of formation of headache in these cases is multifactorial and includes: irritation of the membranes of the brain against the background of increased intracranial pressure, tension or dilation of cerebral vessels, pressure on pain-sensitive structures, hyperimpulsation in the affected nerve trunks, etc. In all cases, along with other pathogenetic mechanisms of headache formation, there is psychogenic . At the same time, psychogenic headaches exist both at the acute stage of the disease and at the stage of residual changes, taking into account the psycho-traumatic effect of any infectious disease of the nervous system.

3. Tension headaches . This type of headache occurs most often and is associated with prolonged static load on the cervical spine. The headache is realized through irritation of the structures of the sympathetic nerve plexus of the vertebral artery at the level of C5-C7 vertebrae, as well as irritation of the roots of the spinal cord C2-C3.Involutionary, degenerative, post-traumatic changes in the cervical spine contribute to such reactions. In these situations, headaches have a fairly characteristic localization in the occipital region, “covering”, squeezing the head like a “helmet”. Often there is palpation soreness of the cervical spine, a feeling of stiffness in the muscles of the neck, subjective limitation of neck mobility, tingling sensations, “creeping creeps”, burning in the occipital region are possible.

4.Psychogenic headaches . This type of headache is provoked by psychoemotional stress of various origins both within the framework of physiological reactions (to various everyday situations, changes in health, etc.), and to be one of the manifestations of a mental disorder (schizophrenia, manic-depressive psychosis, obsessive-compulsive disorder, etc.) etc.). The nature of psychogenic headaches can vary significantly – from local, spastic, pulsating to diffuse, diffuse.

5. Headaches associated with cerebral vascular reactions . The causes of arterial vascular headaches can be various conditions accompanied by the expansion of the lumen of the carotid, vertebral arteries at the extracranial level, as well as large arteries of the base of the brain (middle, anterior, posterior cerebral arteries). The main ones are: lowering blood pressure, the introduction of medications that cause polysegmental vasodilator reactions (nitroglycerin, papaverine, etc.)acute thrombosis or thromboembolism in large arterial trunks, increased intracranial pressure, accompanied by stretching of the walls of the deep veins of the brain, irritation of the meninges. Headaches of a similar origin of a constant nature, of varying intensity, are often described by patients as a feeling of heaviness in the head with a predominance in the forehead and eyebrows. “Venous” headaches prevail in the morning hours, accompanied by swelling (swelling) of the upper half of the head, forehead.

6. Migraine – a special type of headache , the development of which is based on a complex of pathological changes in various parts of the human body, including hormonal disorders of various origins (associated with the pathology of the pelvic organs, thyroid gland, pituitary gland, hypothalamus, hormonal means, including contraceptives, etc.), violations of neurogenic regulation of vascular tone, the presence of pathological activity of neurons in the brain.

Migraine – painful, as a rule, long-term systematic repeated attacks of headache – is a paroxysmal condition . In this regard, it can be attributed to the so-called “minor” epilepsy. A migraine attack in different people is triggered by various factors, but the clinical course is usually quite the same.

The main provoking factors include:

– increased blood pressure

– psycho-emotional stress

– fluctuations in the level of hormones in the second phase of the menstrual cycle

– drinking alcohol (especially – red wine)

– fluctuations in atmospheric pressure.

At the same time, each of these factors in one way or another provokes the development of a spastic reaction of the cerebral arteries and subsequently initiates the first phase of a migraine attack.

In its development , a migraine attack goes through four phases:

1st phase spastic (cerebral arteries are narrowed), not accompanied by headache;

2nd and 3rd phases – dilatatory (cerebral arteries are paralytic), underlying a painful headache

4th phase – the stage of residual (residual) changes (the tone of the cerebral arteries gradually returns to its original state).

In the first phase of the attack, a variety of symptoms (visual, coordinating, motor, etc.) may appear, which are of a short-term nature and are completely reversible. This type of migraine is called aura migraine.

In the second and third phases of the attack, intense headaches develop, often of the type of hemicrania (pain in half of the head), behind the eye, while it hurts to touch the scalp, photophobia, nausea, vomiting can be observed, loud sounds irritate.

After the end of the migraine attack, weakness and drowsiness develop. In the interictal period, there are no objective clinical signs of the disease.

The process of examination and identification of the causes of headache in each patient with cephalgia is even more complicated. This is due to the fact that in the overwhelming majority of patients, the causes of headache are functional in nature and do not lead to visible structural rearrangements both in the brain itself and its vascular system, and in the structures and tissues adjacent to them.

Obvious are the causes of headache only when a patient is identified, according to imaging techniques, of volumetric brain lesions, post-traumatic changes, signs of damage to the membranes of the brain, signs of inflammatory lesions of the paranasal sinuses and other organic processes of cerebral and precerebral localization.

In other situations , in which tension headaches and psychogenic headaches develop, as well as migraine , there are no visible changes in the brain matter.The signs of damage to the vascular system and the spinal column revealed in this case are most often nonspecific.

Certain diagnostic information can be provided by study of vessels and blood flow parameters in their lumens at extra- and intracranial levels, as well as an assessment of flows in the deep veins of the brain. In this case, not only background studies are important, but also reactions to stress testing , which allow assessing the presence of regulatory tonic states caused by both fluctuations in systemic arterial pressure and secondary extravasal effects, for example, from bone structures.

The optimal diagnostic method for these purposes is ultrasound, namely, duplex scanning of extra- and intracranal segments of the brachiocephalic arteries with functional stress tests of myogenic and metabolic orientation.

To detect structural changes in the brain, bone formations , etc. the optimal diagnostic method is magnetic resonance imaging of the brain (with contrast enhancement if necessary).Verification of changes in the cervical spine, often provoking headache syndrome, is carried out by the method magnetic resonance imaging or computed tomography.

To prescribe adequate treatment for patients with migraine, it is sometimes required to conduct electroencephalography , which makes it possible to objectify disturbances in the bioelectrical activity of the brain, contributing to the occurrence of paroxysmal conditions.

At the same time, everyone who seeks help for a headache should know that any instrumental and laboratory examination that is proposed to be carried out is absolutely useless if its results are not evaluated by a competent clinician (neurologist) who is able to fully analyze the existing disorders and prescribe an individualized (suitable for you) course of treatment.

At the Multidisciplinary Professorial Medical Center “Vascular Clinic on Patriarch’s” we offer only similar approaches to patients with headache.

Diagnostic search is aimed at eliminating the organic causes of its occurrence and establishing the development mechanism.

Treatment is selected individually, no “template” schemes are used. Therapy is prescribed only taking into account general pathological changes – the presence (absence) of arterial hypertension, metabolic syndrome, and other pathological processes.

What is offered by the MPMC “Vascular Clinic on Patriarch’s” for headaches

At the MPMC “Vascular Clinic on Patriarch’s” for people with headaches, we offer a full examination, including:

ultrasound examination of the heart,

any vessels (aorta, vessels of the neck and brain, lower extremities, renal arteries, etc.)etc.),

vascular reactivity,

vascular endothelial function,

properties of the vascular wall,

complex of laboratory tests, including hormonal status;

electrocardiography,

Holter ECG monitoring,

daily monitoring of blood pressure levels.

If necessary, in the conditions of an agency clinic, any computed tomography and magnetic resonance procedures can be performed for the clients of our center.

We also offer an absolutely unique method used only in large scientific centers –

transcranial Doppler monitoring with microembolodetection (the only method of in vivo verification of embolism in the cerebral vessels).

Our leading specialists – professors and doctors with vast scientific and practical experience – will select the optimal therapy for your child.

We offer you consultations of the best specialists:

Lelyuk Svetlana Eduardovna – neurologist, angiologist – adolescents from 15 years old

Malmberg Sergey Alexandrovich – pediatric neurologist, neurophysiologist – children of any age

Ramazanov Ganipy Ramazanovich – neurologist – adults

For in-depth examinations, our clinic has special programs for examining patients for the prevention of stroke and acute coronary syndrome.

If you or your child have headaches, please contact us.

We will conduct an examination and prescribe treatment.

We have all the possibilities for early detection of signs of various vascular diseases.

We are ready to select an effective therapy for both prevention and treatment of complications.

At your service – modern medicines at affordable prices in our pharmacy.

You can find out all the details by going to the appropriate sections of the site or by calling +7 (495) 650-00-72 or +7 (926) 000-20-08.

We will be glad to see you in our clinic.

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A repeated consultation of one specialist is considered within 30 days from the date of the previous appointment.On the 31st day from the previous visit to a specialist of this profile, the consultation will be primary.

Doctor-cephalgologist in Chelyabinsk – reception and consultation at the medical center “All Medicine”

Cephalgologist – a doctor who diagnoses the causes and treatment of headaches.For Chelyabinsk, this is still a novelty, but practice shows that the services of a cephalgologist are required by a significant percentage of the population.

Why does the head hurt?

Headaches are primary and secondary. Secondary, as a rule, are symptoms of other diseases, but there are not so many of them, only 5%. However, a non-specialized doctor may not always be able to correctly identify the cause of a headache. Therefore, people have been treating cervical osteochondrosis or vegetative-vascular dystonia for years in the hope of getting rid of frequent headaches.And the reason is not at all in these diseases, and only a cephalgologist can understand such a difficult situation.

In general, a headache, especially if its episodes occur more often than once a week, must be taken seriously. Special attention should be paid to the following symptoms:

Thunderous headache that increases in intensity;
severe headache accompanied by nausea, vomiting, increased blood pressure, loss of consciousness;
night headaches;
Frequent headaches (more often than once a week), especially if close relatives have ever been diagnosed with systemic or cancer diseases.

Everything hurts, nothing helps

Frequent migraine headaches are often caused by uncontrolled use of painkillers. If the intake of analgesics goes beyond 8 tablets per month, then we can talk about drug dependence. You need to resolutely get rid of it and deal with the treatment of the true cause of the headache.

However, the leaders in the frequency of occurrence are migraines and tension headaches. The latter is becoming more common due to lifestyle and increased stressful situations.It is caused by muscle spasm of the cervical-collar zone, psychoemotional stress, unhealthy diet, bad habits, heavy physical exertion and even overweight. The nervous system cannot cope with such pressure and reacts to it with a headache. It is necessary to treat such attacks in a comprehensive manner, first of all – to change the way of life.

Head remedy

Most importantly, there is no need to postpone the visit to the doctor, because migraine is a rather serious disease that significantly reduces the quality of life and a person’s ability to work.If she goes into the chronic stage, then her treatment will be delayed. The cephalgologist knows everything about headaches, therefore, he will select an adequate treatment, and if necessary, he will conduct a comprehensive examination or send for consultations to the necessary specialists if the headache is of a combined nature and is secondary.

There are not many specialists in Chelyabinsk and the Chelyabinsk Region dealing with the treatment and prevention of headaches. One of them is conducting an appointment at the All Medicine clinic. The cost of admission can be found on the website or at the reception by phone 240-03-03.

Department of Cardiology at the Hartman Clinic

The results of blood tests will allow complete information on the state of the heart, blood vessels and internal organs, exclude acute heart damage and concomitant pathologies, assess the likelihood of developing coronary heart disease, heart failure, the risks of cardiovascular complications, and choose an effective medicine.

Heartman Clinic uses a wide range of instrumental diagnostic methods aimed at studying the anatomical functional characteristics of the heart and vascular system.

Electrocardiography
Echocardiography or ultrasound of the heart
Doppler ultrasound examination of the vessels of the arteries of the veins of all localizations
Daily Holter manitoning ECG
Daily blood pressure monitoring (SMAT)
Load tests
Highly informative track Schiller

Timely treatment, detection, treatment of diseases of the cardiovascular system allows you to prevent all complications that may occur.Treatment of cardiovascular diseases at the Heartman Clinic uses the most modern drugs, care for cardiac patients is provided both on an outpatient basis and, if necessary, on a day hospital basis.

The drug treatment regimen is selected individually for each patient, taking into account the level of blood pressure at the stage of diseases, the presence of various risk factors for concomitant diseases.

Thanks to the extensive practical experience of the Heartman Clinic cardiologists, the use of complex drug therapy allows achieving the maximum effect in the treatment of most diseases of the heart and blood vessels.

Cardiovascular diseases require constant monitoring by a cardiologist.

Heartman Clinic cardiologists guide their patients and develop individual rehabilitation programs, give detailed recommendations on the lifestyle with heart disease. Cardiological rehabilitation involves not only the restoration of the body after the cure of cardiovascular diseases or surgery, but also a set of preventive measures. Cardiac rehabilitation includes:

Medical rehabilitation
Physical rehabilitation
Monitoring the patient’s condition

Comprehensive cardiological rehabilitation and follow-up of all patients who have applied to Heartman Clinic not only allows you to restore health after previous diseases, but also normalizes the work of the cardiovascular system if possible, and also reduces the likelihood of repeated heart attacks and relapses of the disease in the future.

Ultrasound diagnostics

Ultrasound
diagnostics – an examination method that allows you to see the structure of the brain
or to evaluate the structure of blood vessels and the movement of blood in them. This study
absolutely painless and can be carried out
newborn children and elderly patients. In the clinic of neurology “NEO”
highly qualified ultrasound doctors, teachers of the department are receiving
ultrasound diagnostics of the Kazan Medical Academy, employees with
long experience of work in children’s hospitals.Our doctors of ultrasound diagnostics perform ultrasound of cerebral vessels for children and
adults , Ultrasound of the neck vessels for children and
adults , Ultrasound of the brain for children
through an open fontanelle (up to a year of life). In addition, at the medical center
We perform NET ultrasound of the abdominal organs , ultrasound
pelvic organs , Thyroid ultrasound
glands . Our specialists have developed a comprehensive study of ultrasound for young children :
the program includes examinations of the organs of the thoracic and abdominal cavity, ultrasound – the brain
children and examination of the hip joints.

Research
Ultrasound is very affordable and painless. Unlike MRI, in order to study
the brain by ultrasound does not need to be anesthetized.

Indications
for ultrasound of the brain in children are: difficult childbirth, birth trauma of the nervous system and
its consequences, delayed motor and mental development of the child,
child anxiety, sleep disturbance in children, head tilting, suspicion
on intracranial pressure.

Ultrasound
vessels of the neck and brain are recommended for children with headaches, children with
developmental delay, decreased vision, hyperactivity and attention deficit.

Ultrasound
organs of the abdominal cavity is recommended for children who have problems with work
organs of the gastrointestinal tract – liver, stomach, pancreas and
gallbladder.

For children
with increased fatigue, difficulty concentrating, constipation,
irritability it is recommended to pay attention to the work of the thyroid gland
for this it is necessary to conduct an ultrasound of this organ.

You can register your child for an ultrasound scan in Kazan to the experienced doctors of the NEO Center by
phone 8 (843) 245-26-26.We also help in the treatment of neurological
diseases and we carry out osteopathic
treatment .

Cholesterol plaques in the vessels: treatment, removal, symptoms

How to treat atherosclerosis

The goal of therapy is to relieve symptoms and prevent stroke. Which treatment is used in each case depends on the degree of narrowing of the lumen of the neck vessels and possible complications. If the stenosis of the carotid artery is asymptomatic, then drug therapy is used when the lumen of the vessel is narrowed up to 70%.

How to remove plaque in the vessels of the neck using drugs? Statins and fibrates are used to lower cholesterol levels. The first group includes atorva-, rose-, simvastatins. They inhibit the formation of atherosclerotic plaques, reduce their size (in the early stages). Of the fibrates, fenofibrate and clofibrate are more commonly prescribed.

In atherosclerosis, patients are prescribed drugs from the group of anticoagulants (antiplatelet agents). The main representative is acetylsalicylic acid in low doses (cardioaspirin).Antiplatelet agents prevent platelet sedimentation, cleanse blood vessels from blood clots, prevent the spread of clots in the arterioles of the brain. In addition to cardioaspirin, this group includes clopidogrel.

It is necessary to simultaneously treat the underlying and concomitant diseases:

chronic renal failure;
arterial hypertension;
metabolic syndrome;
diabetes mellitus.

It is necessary to solve two problems at the same time: how and when to get rid of plaque in the vessels of the neck.It is possible to remove or reduce formations in vessels only in the early stages, before calcification. It is impossible to dissolve hard plaques saturated with calcium salts. Thanks to the use of medications, the progression of atherosclerosis slows down or stops completely. If the drugs are ineffective, then surgery is used.

Varieties

The deposition of cholesterol accumulations has a different place of localization, for example, an ailment affects the vessels of the brain.

Cholesterol plaques can form on any part of a large vessel, which is extremely dangerous, as it can lead to serious complications.Based on the localization criterion, atherosclerosis is distinguished:

aorta;
coronary and vertebral arteries;
cerebral vessels;
arteries of the kidneys, abdominal cavity, lower extremities.

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Symptoms of the disease

Narrowing of the cervical artery in atherosclerosis itself is not felt. Often, symptoms appear only years after the onset of the pathological process. With stenosis of the cervical vessels as a result of restriction, in the worst case – the cessation of blood flow, there are signs of a stroke.

Symptoms of plaques in the cervical vessels:

headaches;
weakness;
tinnitus;
sleep disorders;
dizziness;
hearing impairment;
blurred vision;
inability to control movements;
Numbness or tingling sensation in one side of the body.

With a microstroke, these symptoms usually disappear within 24 hours. If the above symptoms are supplemented by speech disorders, unilateral paralysis of the face, then this means the development of a stroke.It is necessary to call an ambulance as soon as possible, as the count goes for minutes.

The sooner medical assistance is provided to the victim, the greater the chances of restoring brain function.

When other parts of the bloodstream are affected, characteristic symptoms also appear. If atherosclerotic plaques have formed in the leg, the patient has cramping pain in the leg when walking (intermittent claudication). Warning signs cannot be ignored, they help early recognition of atherosclerosis.

The following methods are used for medical diagnostics: angiographic, ultrasound, Doppler vascular examination. A biochemical blood test is performed to determine the cholesterol content.

Tension headache

Tension headache (HDN) – what is it and how is it treated? Our doctor neurologist Nina Vladimirovna Vaschenko tells and answers your questions in the comments.

Tension headache – usually mild to moderate in intensity pain, evenly distributed throughout the head.It is most often described as the feeling of a hoop or helmet on the head, more like squeezing and pressure than pain.

Symptoms of HDN can be as follows:

dull, aching headache;
Feeling of constriction or pressure on the forehead, temples and / or back of the head;
Hypersensitivity of the scalp, tension in the muscles of the neck and shoulders.

This is the most common type of primary headache (that is, it is a headache in itself, and not a symptom of another disease), which occurs periodically in almost all people, but in women it is slightly more common.The most common provocateur of this pain is stress.

Tension headaches can be episodic or chronic. These diagnoses have the following criteria:

Episodic – bothering up to 15 days a month for at least three months in a row. The attack lasts from 30 minutes to a week.
Chronic – bother you from 15 days a month for more than three months in a row. The attacks can last for hours, or they can be continuous.

Sometimes tension headaches are difficult to distinguish from migraines.In addition, people with frequent tension headaches may also suffer from migraines. But, unlike some forms of migraine, tension headaches are usually not associated with visual symptoms, nausea, or vomiting. Physical activity, which usually aggravates migraine pain, does not affect tension headaches and may even improve overall well-being. Tension headaches may be hypersensitive to light or sound, but these are rare symptoms for her.

When to see a doctor?

If tension headache disrupts quality of life.
If you need to take your headache medicine more than twice a week.
If your headaches begin to manifest themselves differently (sometimes headaches can indicate other, more serious diseases).

Treatment of tension headaches is a balance between developing healthy habits, finding effective non-drug treatments (for example, relaxation techniques are suitable here) and medication correctly selected by the doctor.

Combining medication with relaxation techniques may be more effective than medication alone.Use whatever will help you relax and relieve this pain (deep breathing, yoga, meditation, mindfulness, and progressive muscle relaxation). Relaxation techniques can be learned in class or at home from books or videos.