Multiple sclerosis presenting initially with a worsening of migraine symptoms

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6–28.5%; however, it remains unclear whether headache is a true symptom of MS onset. Here, we report the case of a female patient who had a history of migraine without aura and experienced worsening of migraine-headache symptoms as the initial manifestation of MS. Three similar cases were reported previously; however, unlike this case, those cases had no history of migraine without aura. In our case, we excluded factors that could trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger. The patient had one episode of MS attack with the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions, including hyperintense lesions in the bilateral periventricular white matter, body of the corpus callosum, and periaqueductal grey matter, as observed on the T2-weighted images obtained at the first brain magnetic resonance imaging. In addition, after the injection of gadolinium contrast, ring enhancement over these lesions was noted in T1-weighted images, which was suggestive of active demyelination. MS was diagnosed according to the McDonald criteria (2010 revision). We conclude that MS with periaqueductal grey matter involvement may present with worsening migraine. It is important to be cautious if any secondary causes exist, especially when the patient has a history of migraine without aura. MS should be one of the differential diagnoses in young women showing a change in headache pattern or poor clinical drug response to migraine treatment accompanied by episodes of focal neurological deficit. Failure to recognize MS may lead to inappropriate treatment and worse prognosis; early diagnosis in patients with MS is essential to improve their clinical outcomes and quality of life.

Status migrainosus as an initial presentation of multiple sclerosis

“…The prevalence of migraine in patients with MS is between 20% to 45% (Kister et al 2010b ). The diagnosis of migraine precedes MS in most cases (Kister et al 2010a ; Fragoso & Brooks 2007 ; Yetimalar et al 2008 ; Villani et al 2008 ) and it is suggested to be a presenting symptom of MS (Kister et al 2012 ; Zorzon et al 2003 ; Lin et al 2013 ). Freedman et al reported migraine headache at MS onset in 18 (1.6%) out of 1113 patients with MS and an additional 26 (2.3%) patients experiencing recurrent headaches at the time of MS exacerbation, often accompanied by posterior fossa signs (Freedman & Gray 1989 ).…”

The Biological Functions, Structure and Sources of CXCL10 and Its Outstanding Part in the Pathophysiology of Multiple Sclerosis

“…MS usually commences in early adulthood, with paralysis, sensory disturbances, lack of coordination and visual impairment among its most frequent features [3]. The disease often begins with an ‘attack' or ‘flare' that lasts from a few days to weeks and is followed by remission that most often lasts from a few months to years [4,5]. The variable course of the disease may be reflected in the differences seen at the morphological level by magnetic resonance imaging and histopathologic evaluations of the CNS, which also vary significantly [6].…”

Pain and Vertebrogenic Syndromes in Patients With Multiple Sclerosis (Review of Literature)

“…Треба враховувати також патологічні зміни опорно-рухового апарата, які пов'язані зі значним прискоренням розвитку остеопорозу, який веде до швидкого прогресування остеохондрозу хребта (здебільшого попереково-крижового відділу) й артрозів суглобів нижніх кінцівок [3,4,8,13,22].…”

“…It is also necessary to consider pathological changes of the musculoskeletal system associated with a signifi cant acceleration of osteoporosis, that leads to rapid progression of the spinal osteochondrosis (mainly located in lumbosacral area) and to that of lower extremities' arthrosis [3,4,8,13,22].…”

“…In fact, in MS patients with plaques in this area, as well as in the midbrain, the risk of migraine-like states is 4-fold higher as compared to patients with no involvement of the abovementioned site [20]. Several cases were described in the medical literature where the onset or deterioration of the already existing migraine were MS manifesting symptoms [21,22]. The same may be said of cluster headache [23].…”