Friday, 23 October 2015

ClinicSpeak: MS and migraine

Are you a migraine sufferer or migraineur? #ClinicSpeak #MSBlog #MSResearch

"The study below confirms that MSers are prone to develop migraine headache. New onset migraine in an MSer is what we would refer to as secondary migraine. In short migraine is commoner in almost all brain diseases. We know that migraine is probably triggered by overactivity of a group of neurones in the deep gray matter of the brain. It is likely that MS triggers these cells to become active to cause migraine headache. How this occurs is unknown."

"The study below suggests that MSers with migraine have more active disease; i.e. a higher lesion numbers on MRI and more active lesions. This may suggest that MSers with more disease are more likely to have lesions in the critical area that triggers headache."

"I don't agree with their conclusions that MSers with migraine, 'possibly require more frequent MRIs and also more efficient anti-inflammatory treatment'. I would suggest we simply manage MSers with migraine as we do all other MSers with active disease, i.e. with a treat-2-target approach of NEDA."


"If you suffer from migraine please discuss it with your neurology team we have effective treatments to reduce the frequency and severity of migraine attacks."

Graziano et al. Increased contrast enhancing lesion activity in relapsing-remitting multiple sclerosis migraine patients.
Neuroimage Clin. 2015 Aug 1;9:110-6. doi: 10.1016/j.nicl.2015.07.013. eCollection 2015.


BACKGROUND AND OBJECTIVES: While the literature supports the idea that multiple sclerosis (MS) and migraine are related, the exact mechanism(s) of this association is not well understood. Observations of increased contrast enhancing (CE) lesion activity in individual MS patients suffering from migraine prompted us to determine a relationship between migraine and MRI outcomes in a large cohort of MS patients.

METHODS: We included 509 MS and 64 clinically isolated syndrome (CIS) patients and 251 age- and sex-matched healthy individuals (HIs) who obtained 3 T MRI and were assessed for history of migraine. Number and volume of T2, T1 and CE lesions and brain volume measures were determined. The MRI findings were analyzed adjusting for key covariates and correcting for multiple comparisons.


RESULTS: More MS (22.2%) and CIS (17.2%) patients had migraine, compared to HIs (14.6%, p = 0.067). More MS patients with migraine presented with CE lesions compared to those without (35.4% vs. 23.7%, p = 0.013). MS migraine patients had significantly increased number (p = 0.019) and volume (p = 0.022) of CE lesions compared to those without. In the regression analysis, MS migraine patients had an increased number of CE lesions (B = 1.242, p = 0.001), specifically those with relapsing-remitting disease course (B = 1.377, p = 0.001). No significant association of other MRI measures and migraine was found in MS and CIS patients or in HIs.


CONCLUSIONS: Our findings suggest an increased inflammatory pathobiology in MS patients with migraine headaches requiring possibly more frequent MRIs and also more efficient anti-inflammatory treatment.

1 comment:

  1. I was very prone to migraines, and thought this an unavoidable consequence of my PPMS. But since I cut eggs out of my diet, my migraines have reduced by at least 90%. I would strongly urge anyone with regular migraines to examine their diet and experiment with cutting out common allergens.

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