Friday, 29 May 2015

Headache, hmm?

Neurol Sci. 2015 May;36(Supplement 1):75-78.

Headache in multiple sclerosis and autoimmune disorders.

La Mantia L, Prone V.

The headache may be considered among the neuropathic pain syndromes of multiple sclerosis (MS). Several studies have showed that it is more frequent in MS patients than in controls or general population. Headache may occur at the pre-symptomatic phase, at clinical onset and during the course of the disease. Tension-type headache and migraine without aura are the most common primary headaches reported in MS patients. The disease-modifying therapies, such as interferons, may cause or exacerbate headache, although the new available treatments do not seem to increase the risk of pain. Pharmacological and not pharmacological approach may be considered in selected patients to prevent the risk of headache, ameliorate quality of life and increase the adherence to treatment.


Are headaches simply a nuisance, bad luck or an imprecation of divine punishment? It's a disease with 100% penetrance in the human population. 

The association between headache and MS ranges anywhere between 4 and 69% (the wide reported ranges are due to differences in study design, participants etc.) but it's still higher than in the control groups (by more than 50%).

The most commonly reported headaches according to this article are:
  • Tension-type headache - a dull ache across your forehead, or on the sides and back of your head
  • Migraine without aura - usually one-sided (but not always) throbbing headache associated with light sensitivity, noise sensitivity, nausea, irritability etc. 
They even report that there is a correlation with the type of MS - migraine is more commonly reported in RRMS, while tension type headaches are more frequent in progressive MS. 

Headache at onset of MS is considered a 'minor' symptom with frequencies of 1.6-28.5%, and wait for it...has also been reported in 'asymptomatic MS' or the so-called radiologically isolated syndrome/RIS.

What about the pathology? 

Headache during an attack of MS appears more likely if there is brain stem involvement, particularly a lesion in the periaqueductal gray matter (PAG) with migraine-like headaches.


What about DMTs?


Interferon-beta (IFN) has had more reports of headache than placebo, and to a smaller extent so has Copaxone, but not the newer drugs (natalizumab, fingolimod, tecfidera, teriflunomide).


So should we opt to scan people presenting with a migraine/tension type headache who also happen to be of the female gender? 


Over 50% of people with brain tumours experience headaches at some stage, but even here it's not considered routine practice...

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