Mrabet Saloua, Wafa Mohamad, Giovannoni Gavin
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Royal London Hospital, Department of Neurology, Barts Health NHS Trust, London, United Kingdom.
Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, United Kingdom; Royal London Hospital, Department of Neurology, Barts Health NHS Trust, London, United Kingdom.
Mult Scler Relat Disord. 2022 Dec;68:104152. doi: 10.1016/j.msard.2022.104152. Epub 2022 Aug 29.
Multiple sclerosis (MS) is a chronic inflammatory disease leading to multifocal neuronal demyelination and axonal damage in the central nervous system (CNS). MS symptoms vary widely but typically do not include headaches. A large spectrum of headaches manifestations was reported as comorbidities in MS and results in additional disability. Migraine, tension-type headache and cluster headache are the most frequently reported primary headache syndromes in patients with MS (pwMS). Secondary causes of headache should be excluded (cerebral vein thrombosis, CNS or systemic infection, cervical and/or cranial trauma, headaches associated with psychiatric disorders, medication overuse headache, etc.) in this particular population. A careful medical history and general and neurological examinations and sometimes further investigations may be needed to rule out secondary headache syndromes. In pwMS, the headache could be an adverse effect of the disease-modifying therapies or a complication of pain medication overuse prescribed to relieve other causes of pain related to MS (neuropathic pain, mechanical pain, pain associated with spasticity, etc.). Migraine-type headache occurs in pwMS more frequently than in the general population. It can precede the disease onset, be associated with relapses, or appear during the MS course. A predominance of brainstem inflammatory lesions is described on magnetic resonance imaging (MRI) in MS patients with migraine. The relationship between both conditions remains unclear. Migraine and MS occur in the same demographic groups with similar background factors, including gender, hormonal status, and psychological features (anxiety, depression, stress). An early diagnosis and adequate treatment of migraine in MS patients are important to improve their quality of life. In this review, we focus on the relationship between MS and Migraine, discuss the differential diagnoses of migraine in pwMS, and describe its management in this particular context.
多发性硬化症（MS）是一种慢性炎症性疾病，可导致中枢神经系统（CNS）多灶性神经元脱髓鞘和轴突损伤。MS症状差异很大，但通常不包括头痛。大量头痛表现被报道为MS的合并症，并导致额外的残疾。偏头痛、紧张型头痛和丛集性头痛是MS患者（pwMS）中最常报告的原发性头痛综合征。在这一特定人群中，应排除头痛的继发性原因（脑静脉血栓形成、CNS或全身感染、颈部和/或颅脑外伤、与精神障碍相关的头痛、药物过度使用性头痛等）。可能需要详细的病史、全面的体格检查和神经系统检查，有时还需要进一步检查以排除继发性头痛综合征。在pwMS中，头痛可能是疾病修饰疗法的不良反应，或是为缓解与MS相关的其他疼痛原因（神经性疼痛、机械性疼痛、与痉挛相关的疼痛等）而开具的止痛药物过度使用的并发症。偏头痛型头痛在pwMS中比在普通人群中更常见。它可以在疾病发作之前出现、与复发相关或在MS病程中出现。在患有偏头痛的MS患者的磁共振成像（MRI）上，可见脑干炎性病变占优势。两者之间的关系仍不清楚。偏头痛和MS发生在具有相似背景因素的相同人群中，包括性别、激素状态和心理特征（焦虑、抑郁、压力）。早期诊断和充分治疗MS患者的偏头痛对于改善他们的生活质量很重要。在这篇综述中，我们重点关注MS与偏头痛之间的关系，讨论pwMS中偏头痛的鉴别诊断，并描述在这一特定背景下的治疗方法。
