Headache in Multiple Sclerosis: Features and Implications for Disease Management (P6.163)

Abstract

OBJECTIVE: The aim of this study was to investigate the variables affecting headache occurrence in patients with multiple sclerosis (MS). BACKGROUND: People with MS have an increased incidence of headaches, although the comorbidity of headaches and MS is poorly understood. Owing to the highly variable presentation of headaches in patients with MS, much remains to be elucidated about the variables affecting headache development. DESIGN/METHODS: In a prospective study at the Drexel University College of Medicine Multiple Sclerosis Program, 72 patients with both MS and headaches anonymously completed a 28-item questionnaire. This evaluation assessed each patient’s demographics, headache description and modifying factors, relation to MS progression, social history, and impact on quality of life. RESULTS: Our patients reported a wide spectrum of headache presentations and resulting disability. Fifty-two percent of our patients experienced headaches at least once a week (P < .001). Migraines with aura strongly correlated with MS exacerbations (P < .003), and were newly diagnosed in 64% of patients following MS onset. Patients who experienced sharp and stabbing headaches were more likely to report an increase in headache severity during MS flare-ups (P < .04), and this pain description was significantly associated with stress and fatigue triggers (P < .001 and P < .01, respectively). Quality of life was impaired in our sample population, with 43% reporting that their headaches were severe very often or always (P < .001). CONCLUSIONS: Due to the severity of headache in MS patients and resulting impact on quality of life, a thorough analysis of headache presentation is warranted in such patients. MS patients experiencing migraines with aura and sharp pain should be evaluated for MS relapse. Migraine with aura may also be a presenting sign of disease onset. Preventable headache triggers should be evaluated to reduce headache attacks and improve patient functioning.

Disclosure: Dr. Wilcox has nothing to disclose. Dr. Tabby has received personal compensation for activities with Biogen Idec as a speaker. Dr. Tabby has received research support from Sanofi-Aventis Pharmaceuticals Inc., and Bayer Pharmaceuticals Corp. Dr. Majeed has nothing to disclose. Dr. Youngman has nothing to disclose.