Husain Farhat, Pardo Gabriel, Rabadi Meheroz
Department of Neurology/Rehabilitation, Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.
Oklahoma Medical Research Foundation, MS Center of Excellence, Oklahoma City, USA.
Curr Treat Options Neurol. 2018 Mar 24;20(4):10. doi: 10.1007/s11940-018-0495-4.
The purpose of this review was to discuss the prevalence, impact, pathophysiology, and treatment of headaches (H/As) in patients with multiple sclerosis (MS).
Headaches and multiple sclerosis are more common in women than in men with the ratio of female to male being 3:1. It is not entirely clear if there is a correlation or an incidental comorbidity of two neurological conditions. A review of the literature shows a variable prevalence of H/As in MS patients. Using the International Classification of Headache Disorders (ICHD) criteria, the primary type of H/As, especially migraine, is the most common type seen in patients with MS. One of the theories of the pathophysiologic mechanisms of migraine in MS patients is inflammation leading to demyelinating lesions in the pain-producing centers in the midbrain. Secondary H/As due to MS medications such as interferons are also frequently present. H/As can be a cause for significant comorbidity in patients with MS. The treatment of H/As in patients with MS should be addressed in the same fashion as in the non-MS population, which is a combination of pharmacological and non-pharmacological methods. Preventive medicines for the H/As should be carefully selected because of their side effect profiles. Acute attacks of migraines can be treated with medications such as triptans. Patients with MS who have migraine H/As should be educated about the phenomenon of overuse H/As, keeping headache journals, avoiding stress, and monitoring sleeping habits. The presence of depression in patients with MS and migraine affects quality of life (QOL) and should also be addressed for better outcomes.
本综述旨在探讨多发性硬化症（MS）患者头痛（H/A）的患病率、影响、病理生理学及治疗方法。
头痛与多发性硬化症在女性中比在男性中更常见，女性与男性的比例为3:1。目前尚不完全清楚这两种神经系统疾病之间是存在相关性还是偶然的合并症。文献综述显示，MS患者中H/A的患病率各不相同。根据国际头痛疾病分类（ICHD）标准，H/A的主要类型，尤其是偏头痛，是MS患者中最常见的类型。MS患者偏头痛病理生理机制的理论之一是炎症导致中脑疼痛产生中心的脱髓鞘病变。由MS药物如干扰素引起的继发性H/A也很常见。H/A可能是MS患者显著合并症的一个原因。MS患者H/A的治疗应与非MS人群采用相同的方式，即药物治疗和非药物治疗相结合。由于预防性药物的副作用，应谨慎选择用于H/A的预防性药物。偏头痛的急性发作可用曲坦类药物等进行治疗。患有偏头痛性H/A的MS患者应接受关于H/A过度使用现象、记录头痛日记、避免压力和监测睡眠习惯的教育。MS合并偏头痛患者中抑郁症的存在会影响生活质量（QOL），为了获得更好的结果也应予以关注。
