Patients with MS and migraine have a greater number of relapses and cognitive symptoms than MS patients without migraine and experience a “markedly more symptomatic MS course.”
SEATTLE—Patients with multiple sclerosis (MS) reported a threefold increase in migraine frequency compared with age- and gender-matched controls, according to findings presented at the 61st Annual Meeting of the American Academy of Neurology.
Ilya Kister, MD, Assistant Professor at New York University (NYU) School of Medicine in New York City, and colleagues distributed questionnaires to 225 patients in the waiting room of the NYU MS Center. Ninety percent (n = 204) completed the survey. Results were analyzed to compare migraine rates in MS patients with those of matched historical controls from the American Migraine Prevalence and Prevention (AMPP) study. The researchers also compared symptom profiles and severity of MS in patients with migraine and those with no headache, assessed for possible associations between migraine and other conditions in patients with MS, and compared brain MRI characteristics in MS patients with and without migraine.
Frequency and Characteristics of Migraine in MS Patients
According to Dr. Kister and colleagues, the overall headache frequency was in the range reported in previous studies of headache in MS patients. Sixty-four percent of patients (n = 131) reported “a headache within the past year not related to trauma, infection, or medication.” Of these, 94 (72%) met International Classification of Headache Disorders, Second Edition criteria for migraine; the remaining 37 (28%) met criteria for tension-type headaches.
The one-year prevalence of migraine among patients with MS was threefold greater than that of the general population (AMPP cohort), both for men (18.4% vs 5.6%) and women (55.7% vs 17.1%). Thirty-six percent of MS patients with migraine reported aura. The frequency of migraine with aura and distribution of aura types was similar to that of patients with migraine in the AMPP study.
Migraine severity, which was determined using the Migraine Disability Assessment Scale (MIDAS), did not differ between the MS and AMPP cohorts. Seventy-seven percent of MS patients with migraine and 75% of AMPP subjects with migraine had mild to moderate disability (MIDAS grades 1 and 2), while the remainder had frequent and severe migraine disability (MIDAS grades 3 and 4).
MS Relapses, Painful and Nonpainful Symptoms, and MRI Characteristics
MS patients with migraine self-reported more relapses than did those without migraine. Among MS patients with migraine, 28% reported three or more relapses during the past year and 20% had none. In contrast, among MS patients without headache, 10% had three or more relapses during the past year, and 32% had none. More MS patients without headache had no relapses compared with MS patients with migraine.
Pain-related symptoms, such as Lhermitte’s sign, occipital and trigeminal neuralgia, facial pain, temporomandibular joint-related pain, spasms, and restless legs syndrome, were 2.5 times more common in MS patients with migraine than in those without headache. Twenty-six percent of patients with migraine reported frequent, non–headache-related allodynia. In addition, more than 20% of migraineurs reported using analgesics for nonheadache reasons, compared with 7% of headache-free patients.
Dr. Kister and colleagues also found that MS patients with migraine reported more cognitive, psychiatric, brainstem, and visual symptoms and scored higher on depression and anxiety scales (Patient Health Questionnaire–9), the Fatigue Severity Scale, and the Epworth Sleepiness Scale. No differences were observed in self-reported ambulation scores, hours of sleep per night, and overall quality of life.
Brain MRI scans were available for 138 of the 204 MS patients (67%), including 50 migraineurs and 65 headache-free patients. No differences were observed in the number and distribution of T2 hyperintense lesions or the number of gadolinium-enhancing lesions between the two groups; however, there were more T1 hypointense lesions in the headache-free group.
Recommendations
Because migraines are common and often disabling, Dr. Kister’s team recommended that a headache history be elicited from all MS patients, “as [migraine] is often overshadowed by other MS symptoms and yet can be effectively treated in many cases.”
The researchers concluded that “population-based, prospective studies with objective documentation of relapses and disability, and controlled for interferon-1b use, are necessary to definitively establish an association between MS and migraines, to clarify the nature of the association (unidirectional vs bidirectional), and to confirm our findings that MS migraineurs experience a markedly more symptomatic MS course.”
—Karen L. Spittler