Recognizing migraine in patients with multiple sclerosis improves the quality of health care

Reconhecer a enxaqueca em doentes com esclerose múltipla melhora a qualidade dos cuidados de saúde

Multiple sclerosis (MS) and migraine are both chronic primary diseases of the nervous system that are often highly disabling, leading to a considerable burden to the affected people and to the society as a whole. In the global burden of MS study recently published, MS was described to be a quite rare disease but a potentially severe cause of neurological disability throughout adult life, and its prevalence was found to have increased in many regions since 1990¹. As well, in the global burden of migraine and tension-type headache study, migraine was shown to be the sixth most prevalent disease and one of the ten most disabling disorders worldwide².

The co-occurrence of migraine and MS undoubtedly adds to the burden of disease and negatively influences the quality of life of these patients. However it is still unknown if there is a correlation or an incidental co-morbidity of two neurological conditions that, interestingly, share some typical characteristics: they are more common in women, particularly in the fertile age; usually manifest by recurrent attacks; their diagnosis is mainly based on clinical data.

In the scarce literature dedicated to the assessment of headaches in patients with MS, there are conflicting results: whereas most authors describe that headaches, in particular migraine, are very common in MS and discuss its potential relationship with several disease-modifying drugs (DMD)^3,4,5,6, in a case-control study no association between migraine or tension-type headache and MS was found⁷.

The study of Fragoso YD et al. addressing the presence of migraine in MS patients published in this number of the journal Arquivos de Neuro-Psiquiatria is particularly timely⁸. It is a cross-sectional multicenter study conducted in a large population of patients with MS attended in specialized MS units, with at least one year of diagnosis, who also complained of headache. Data was obtained through an online questionnaire, including the Brazilian validated versions of ID-Migraine and Migraine Disability Assessment Scale (MIDAS) tools, directly answered by the patients and only those that completed all questions entered the study.

Headache was found in 746 MS patients, being five-times more prevalent in women, which the authors explain by the higher prevalence of both conditions in female gender. Migraine was reported in 409 and in 404 (54.1%) out of 743 MS patients, using the ID-Migraine questionnaire and the criteria of the International Headache Society (ICDH-3 beta version), respectively. In 68.3% of the cases there was a moderate or high disability and in 47.2% of patients with migraine and MS had at least 7 days of headache per month. ID-Migraine showed high sensitivity and specificity for assessing migraine in MS, leading the authors to state that is it an easy tool that can be routinely applied in MS clinics.

These results highlight the importance to look for migraine in MS patients in the clinical setting, to assure that a comprehensive management of both conditions is being offered, in order to improve the quality of life of these patients and the quality of health care.

References

• ¹
  GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019 Mar;18(3):269-85. https://doi.org/10.1016/S1474-4422(18)30443-5
  » https://doi.org/10.1016/S1474-4422(18)30443-5
• ²
  GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):954-76. https://doi.org/10.1016/S1474-4422(18)30322-3
  » https://doi.org/10.1016/S1474-4422(18)30322-3
• ³
  La Mantia L, Prone V. Headache in multiple sclerosis and autoimmune disorders. Neurol Sci. 2015 May;36 Suppl 1:75-8. https://doi.org/10.1007/s10072-015-2146-9
  » https://doi.org/10.1007/s10072-015-2146-9
• ⁴
  Husain F, Pardo G, Rabadi M. Headache and its management in patients with multiple sclerosis. Curr Treat Options Neurol. 2018 Mar;20(4):10. https://doi.org/10.1007/s11940-018-0495-4
  » https://doi.org/10.1007/s11940-018-0495-4
• ⁵
  Beckmann Y, Türe S. Headache characteristics in multiple sclerosis. Mult Scler Relat Disord. 2019;27:112-116.
• ⁶
  Sahai-Srivastava S, Wang SL, Ugurlu C, Amezcua L. Headaches in multiple sclerosis: Cross-sectional study of a multiethnic population. Clin Neurol Neurosurg. 2016 Apr;143:71-75. https://doi.org/10.1016/j.clineuro.2016.01.017
  » https://doi.org/10.1016/j.clineuro.2016.01.017
• ⁷
  Gustavsen MW, Celius EG, Winsvold BS, Moen SM, Nygaard GO, Berg-Hansen P, Lie BA, Zwart JA, Harbo HF. Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study. Mult Scler J Exp Transl Clin. 2016 Dec;2:2055217316682976. https://doi.org/10.1177/2055217316682976
  » https://doi.org/10.1177/2055217316682976
• ⁸
  Fragoso YD, Adoni T, Alves-Leon SV, Apostolos-Pereira SL, Carneiro MAD, Chikota EM, et al. Migraine in 746 patients with multiple sclerosis. Arq Neuropsiquiatr 2019;77(9):617-21. https://doi.org/10.1590/0004-282X20190100
  » https://doi.org/10.1590/0004-282X20190100

Publication Dates

• Publication in this collection
  23 Sept 2019
• Date of issue
  Sept 2019

History

• Received
  26 July 2019
• Accepted
  07 Aug 2019