Migraine-Like Headache and Status Migrainosus as Attacks of Multiple Sclerosis in a Child

Abstract

The incidence of headache at the onset of relapsing-remitting pediatric multiple sclerosis (MS) is more frequent than in the adult MS population, but headache as the only symptom of a relapse, both in adults and children, is unusual. Here we describe the case of a 5-year-old child who developed MS and in whom migraine-like headache was the presenting symptom at both the onset of the disease and the following 2 relapses. Moreover, the first relapse was characterized by the occurrence of headache that fulfilled the time criteria for status migrainosus. The presence of headache during MS might depend on the anatomic distribution of lesions. In our case, the demyelinating plaques localized in the midbrain, the periaqueductal gray matter, and the upper cervical cord together with the meningeal reaction and the diffuse brain swelling might have caused the onset of migraine-like headache and the status migrainosus. The causal relationship between headache and MS attacks, in our case, was also confirmed by the improvement of headache under immunomodulatory treatment for MS, because it is known that headache is often caused or exacerbated by interferon beta therapy.

Neuropathic pain in children

“…Multiple sclerosis (MS) is a chronic inflammatory disease producing demyelination and axonal damage in the brain and spinal cord 81. Pain is common in adults with a prevalence from 57% to 65%.…”

“…Sensory symptoms were reported in 13%–69% of children with MS, but not the proportion with NP 82. Headache is more frequent than in adult patients with MS 81. The course of the disease may be slower in children, with higher rates of spontaneous recovery but it can still have a significant impact on schooling and quality of life 82…”

Recurring Migraines as the Presenting Symptom of Pediatric Multiple Sclerosis in a Teenage Girl: A Case Report

“…Both MS and migraines have a predilection for women as opposed to men. 8,9 In addition, both can come across as acute attacks on the body that negatively affect the ability of an individual to function. 9,10 That said, how is one supposed to differentiate the two as an associative concurrent affliction versus the primary causality of the other?…”

“…10 The relapsing-remitting attacks often include painful vision loss, diplopia, spasticity, weakness, numbness, tingling, or neurogenic bladder. 8 That said, migraines are not typically thought of as an "MS" symptom. Kister et al 15 was the first to suggest that migraines might be a presenting symptom of MS rather than just a concurrent nuisance.…”

Migraine Headache as a Presenting Feature of Multiple Sclerosis: A Case Report

“…A few studies reported migraine-like headaches as the first presentation of MS attack. [11][12][13] Status migrainosus as a presenting symptom of MS is much rarer. 14 Herein, we report a case with status migrainosus as an MS attack with new T2 lesions and provide a comprehensive review of MS attacks presenting migraine headaches.…”