Sîrbu Carmen Adella, Rotaru Andreea Ruxandra, Antochi Florina Anca, Plesa Andreea, Manole Aida Mihaela, Roceanu Adina Maria
Clinical Neurosciences Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Neurology, "Dr. Carol Davila" Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania.
Life (Basel). 2024 Jan 5;14(1):87. doi: 10.3390/life14010087.
Multiple sclerosis is a chronic and progressive neurological disease, with an important socio-economic burden. Over time, an increased incidence of headaches like migraines and tension headaches has been observed among these patients. Headaches have not been considered as multiple sclerosis-related symptoms, even representing a red flag for multiple sclerosis diagnosis. It is uncertain whether the headache-multiple sclerosis association could be explained by the presence of common triggers or a common physiopathological mechanism (involvement of tertiary B-cell follicles). An important differential diagnosis is between multiple sclerosis attacks and migraines with aura, which can also be associated with neurological deficits. Another important aspect is the occurrence or exacerbation of the cephalalgic syndrome after the initiation of therapy for multiple sclerosis (DMTs), or the improvement of headache after the initiation of certain DMT drugs. In addition to headaches, individuals diagnosed with multiple sclerosis often report experiencing diverse pain syndromes, contributing to an additional decline in their overall quality of life. These syndromes are frequently neglected, the focus being on slowing down the progression of neurological deficits. This review aims to evaluate the characteristics of multiple-sclerosis-related headaches (frequency, possible correlation with attacks, and disease-modifying therapies) and the key distinctions in imaging characteristics between demyelinating lesions in multiple sclerosis and those observed in cases of primary headaches.
多发性硬化症是一种慢性进行性神经疾病，具有重大的社会经济负担。随着时间的推移，在这些患者中观察到偏头痛和紧张性头痛等头痛的发病率有所增加。头痛一直未被视为与多发性硬化症相关的症状，甚至是多发性硬化症诊断的一个警示信号。头痛与多发性硬化症之间的关联是否可以用共同的触发因素或共同的生理病理机制（三级B细胞滤泡的参与）来解释尚不确定。一个重要的鉴别诊断是多发性硬化症发作与伴有先兆的偏头痛之间的鉴别，后者也可能与神经功能缺损有关。另一个重要方面是在开始多发性硬化症治疗（疾病修正疗法，DMTs）后头痛综合征的发生或加重，或在开始使用某些DMT药物后头痛症状的改善。除了头痛，被诊断为多发性硬化症的个体经常报告经历各种疼痛综合征，这导致他们的整体生活质量进一步下降。这些综合征经常被忽视，重点在于减缓神经功能缺损的进展。本综述旨在评估与多发性硬化症相关的头痛的特征（频率、与发作的可能相关性以及疾病修正疗法），以及多发性硬化症脱髓鞘病变与原发性头痛病例中观察到的脱髓鞘病变在影像学特征上的关键区别。
