ClinicSpeak: migraine headaches and MS

Did you know if you have MS you have more than a 1 in 3 chance of being a migraineur? #ClinicSpeak #MSResearch #MSBlog

"How many of you suffer from headache? Did you know that migraine headache is much commoner in pwMS than in the general population? Why? It now become evident that in migraine is much more common in people who have brain disease in general. It seems as if focal pathology, particularly in the hypothalamus and brainstem areas of  the brain, may trigger migraine. In the study below 36% of pwMS had migraine; this is consistent with other studies and is about double the background risk in the general population. The fact that it is so common means that we should probably include headache on our scorecards when we review pwMS to make sure we are not missing headache. Clearly headache is a very common comorbidity in MS and may be contributing to poor quality of life."

"If you don't manage migraine properly you can convert it into a chronic daily headache,  usually as a result of analgesic misuse, that is very difficult to treat. If you have migraine, or frequent headaches, please discuss this with your neurologist so that you can get proper advice and treatment for your headaches. To make things easier for your neurology team I suggest starting a headache diary to document the frequency and severity of your headaches and how they respond to treatments. The management of migraine is broken-up into three classes of treatment; (1) prophylactic therapies, or strategies, to reduce the frequency of headaches, (2) abortive treatments to try a get rid of the migraine before it builds to a crescendo, these treatments are typically given after the onset of the headache and (3) symptomatic treatments, these treatments are given once the migraine is established, i.e. analgesics and antiemetics for the nausea."

"Would you like a more detailed post on the management of migraine headache in MS, including self-management strategies?"

Epub: Sahai-Srivastava et al. Headaches in multiple sclerosis: Cross-sectional study of a multiethnic population. Clin Neurol Neurosurg. 2016 Feb 1;143:71-75. doi: 10.1016/j.clineuro.2016.01.017. 

OBJECTIVES: Headaches in MS are common, but there is little data on the influence of race, comorbidities, MS disability and socioeconomic issues on headaches, especially migraine. We aimed at looking at prevalence and type of headache across a multiethnic MS population, and relationship between MS related clinical factors and migraine.

PATIENTS AND METHODS: This is a cross-sectional study of 233 MS patients at two clinical sites, one at a county hospital, and the other a private academic center clinic. We collected demographic data, MS characteristics, and headache histories using validated survey instruments including Headache Impact Test (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). The relationship between MS and migraine was examined using logistic regression.

RESULTS: Majority of our patients were female (N=156, 67%), average age 44 years, with relapsing remitting MS (N=214, 92%). Our cohort was multi-ethnic predominantly Whites (N=106, 46%) and Hispanics (N=87, 37%). Public sector patients were significantly disadvantaged in socioeconomic measures (p<0.0001) and younger (40 vs 47 yrs, p<0.0001), compared to the private sector patients who had a higher MS burden. Headaches were common, regardless of sector (N=115, 49.4%), the most common type being migraine (N=83, 36%). Chronic migraine was more common among Hispanics (82%) than Whites (18.2%) (p=0.012). Headache impact on daily life, measured by HIT-6 score (p=0.006) and PHQ-9 score (p=0.004) were significantly higher in the public sector. After controlling for income and education, female gender (OR 2.59, 95% CIs 1.312-5.127) and ambulatory disability were found to be more likely to suffer from migraines.

CONCLUSION: Headache, especially migraine is common among MS patients regardless of socio-economic status and treatment setting. Female MS patients with walking disability and longer disease duration tend to get migraines. Hispanic MS patients have a higher likelihood of suffering from chronic migraines. Thorough headache evaluation and headache treatment are essential to comprehensive MS care.

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