Headache in Multiple Sclerosis

Document Type : Research Paper


1 Associate Professor ofNeurology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident of Neurology, IsfahanUniversity of Medical sciences, Isfahan,Iran


Multiple Sclerosis (MS) is a common neurological disease in young adults with variable clinical symptoms and signs. Many of MS patients experience headache. This study was done to evaluate the prevalence of headache in MS patients.
Materials and Methods
This descriptive cross-sectional study was carried out in MS clinics affiliated to Isfahan university of Medical Sciences in the first six months of 1380. For each patient a questionnaire was filled according to history and examination, and the data was analyzed by SPSS program.
From 100 patients, 67% had headache and 86.6% of them were women .Tension headache in 47.7% and migraine headache in 34.3% was reported. Of 100 patients, 23 of them had migraine headache, 36 patients had history of headache before the onset of MS, whom in 52.8% severity of headache was increased. Of patients 10.4% had headache at the onset of MS and in 6.8% headache was the first symptom of MS. The neurological signs and symptoms were presented after headache.
According to this study different types of headaches are common in MS and the migraine type is more common than in general population.


1 -Clifford DB, Trotter JL. Pain in multiple sclerosis. Arch Neurol 1984; 41:1270-1272.
2- Kenner M, Menon U, Elliott DG. Multiple sclerosis as a painful disease. Int Rev Neurobiol 2007; 79:303-321.
3- D'Amico D, La Mantia L, Rigamonti A, Usai S, Mascoli N, Milanese C, et al. Prevalence of primary headaches in
people with multiple sclerosis. Cephalalgia 2004; 24:980-984.
4- Gee JR, Chang J, Dublin AB, Vijayan N. The association of brainstem lesions with migraine-like headache: an
imaging study of multiple sclerosis. Headache 2005; 45:670-677.
5- Elliott DG. Migraine in multiple sclerosis. Int Rev Neurobiol 2007; 79:281-302.
6- McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, et al. Recommended diagnostic criteria
for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. ANN Neurol 2001;
7- Fragoso YD, Brooks JB. Two cases of lesions in brainstem in multiple sclerosis and refractory migraine. Headache
2007; 47:852-854.
8- Freedman MS, Gray TA. Vascular headache: a presenting symptom of multiple sclerosis. Can J Neurol Sci 1989;
9- Gentile S, Ferrero M, Vaula G, Rainero I, Pinessi L. Cluster headache attacks and multiple sclerosis. J Headache Pain
2007; 8:245-247.
10- Rolak LA, Brown S. Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol 1990;
11- Kalia LV, O'Connor PW. Severity of chronic pain and its relationship to quality of life in multiple sclerosis. Mult
Scler 2005; 11:322-327.
12- O'Connor AB, Schwid SR, Herrmann DN, Markman JD, Dworkin RH. Pain associated with multiple sclerosis:
systematic review and proposed classification. Pain 2008; 137:96-111.
13- Vacca G, Marano E, Brescia MV, Lanzillo R, De Vito M, Parente E, et al. Multiple sclerosis and headache comorbidity.
A case-control study. Neurol Sci 2007; 28:133-135.
14- Martinelli BF, Colombo B, Annovazzi P, Martinelli V, Bernasconi L, Solaro C, et al. Lifetime and actual
prevalence of pain and headache in multiple sclerosis. Mult Scler 2008; 14:514-521.
15- Sandyk R, Awerbuch GI. The co-occurrence of multiple sclerosis and migraine headache: the serotoninergic link.
Int J Neurosci 1994; 76:249-257.