Headache at the Time of First Symptom Manifestation of Multiple Sclerosis: A Prospective, Longitudinal Study

Abstract

Aims: Headaches have not been considered a typical symptom of multiple sclerosis (MS), although since 2000, almost every study showed high prevalence. We screened 50 MS patients at the time of first occurrence of neurological symptoms and found the highest prevalence of headache in MS that was ever recorded (78%). Postmortem histological analyses of MS patients’ brains revealed lymphoid follicle-like structures in the cerebral meninges and a pathophysiological link between headache, and high inflammatory activity especially in the initial phase of MS could be suspected. The aim of this study was to get insights into the persistence of headache in the further progress of the disease. Methods: In a prospective, multicenter study, 50 MS patients at the time of first symptom manifestation were screened for the presence of headache within the last 4 weeks and again 6 months later with help of the Rostock Headache Questionnaire (Rokoko) as well as using the evaluation of case history and clinical-neurological investigation. Results: We found a decrease of headache prevalence after 6 months from 78 to 61% (p = 0.01). We could also show a decrease of headache frequency, measured by days with headache in the last 4 weeks (9.5 vs. 5.9, p = 0.001). Migraine or probable migraine was the most frequent headache. In both investigations, the most frequent headache was recurrent pain with pulsating and throbbing character that lasted between 4 and 72 h. Conclusion: Headaches should be taken seriously as an important symptom in early MS. The decrease of headache 6 months after first symptom manifestation of MS could be a result of the immunomodulatory therapy. Young patients in whom migraine-like headaches occur should obligatory undergo an MRI of the head, and in the case of abnormal findings differential diagnosis should be initiated. This could reduce latency until final diagnosis of MS and enable early treatment.

Pain in NMOSD and MOGAD: A Systematic Literature Review of Pathophysiology, Symptoms, and Current Treatment Strategies

“…Meningoencephalitis-like pathology with fever, severe headache, and pleocytosis in the cerebrospinal fluid (CSF) has been reported in both disease complexes, NMOSD and MOGAD (74,121), most likely due to meningeal inflammation (122,123).…”

The epidemiology of primary headaches in patients with multiple sclerosis

“…After abstract screening and manual searching of references, we search out 62 articles meeting the criteria for full‐text reviewing. Among the 62 articles, 46 were excluded and 16 research articles were included in the final meta‐analysis (Beckmann & Türe, 2019; Busillo et al., 2014; D'Amico et al., 2004; Doi et al., 2009; Gebhardt, Kropp, Hoffmann, & Zettl, 2018; Gustavsen et al., 2016; Katsiari, Vikelis, Paraskevopoulou, Sfikakis, & Mitsikostas, 2011; Kister et al., 2010; Möhrke, Kropp, & Zettl, 2013; Nicoletti et al., 2008; Özer, Ergün, & İnan, 2018; Putzki et al., 2009; Sorgun, Yucesan, & Yasemin, 2013; Srivastava, Wang, Ugurlu, & Amezcua, 2016; Vacca et al., 2007; Villani et al., 2008).…”

The “Treatise on the spleen and stomach” (Pí Wèi Lùn) as the first record of multiple sclerosis in the medical literature – A hypothesis based on the analysis of clinical presentation and herbal medicine

“… Frequent headaches Headaches – a study found high prevalence of headaches in 78% of the MS patients studied. 27 Another study reported 16.3% of MS patients with migraine, 23.5% with tension headache, none with cluster headaches, and 60.2% of the MS patients with headache remained unclassified. 28 Rigidity of the tongue and inability to take food in easily Dysphagia – in a study, 31.7% of the MS patients were classified as having dysphagia.…”

“…Pain is a problem encountered in at least 50% of MS patients 26 , and headaches are common in 78% of the cases. 27 , 28 Another series of manifestations may be attributed to a dysfunction of the autonomic nervous system (ANS) such as “ cold inversion in the morning and evenings, spontaneous sweating, and feeling of Yin Qi shrouding the skin and hair ”, the latter explained as “ chills or a feeling of cold ”. 29 , 30 The “ difficulty voiding of bound stools ” was identified as constipation, common in 50% of the MS patients.…”