Headaches could be used as an essential early diagnostic symptom for multiple sclerosis (MS), according to a study published in European Neurology.
Researchers analyzed the frequency of headaches early in the MS disease process and again after a follow-up timeframe. They used an interview process and Rostock Headache Questionnaire to determine frequency, duration, type, location, and symptoms to classify the headaches. Data were collected at the onset of first MS symptoms and again at a follow-up appointment 6 months later.
Of the 50 patients with MS, 78% were women, the median age was 30 years old, and the median Expanded Disability Status Scale was 1.5. At disease onset, 78% of patients reported headaches, with this number dropping to 61% 6 months later (P =.01). Headache frequency also dropped from a rate of 9.5 days with headaches over the previous 4 weeks at disease onset to a rate of 5.9 days with headaches over the previous 4 weeks at the follow-up (P =.001).
Women experienced a greater prevalence of headaches, with a rate of 80% at disease onset that dropped to 68% at follow-up. Men had a greater decrease in headache prevalence, with a rate of 73% at disease onset and 36% at follow-up (P <.04). Overall most headaches were classified as migraines or probable migraines, with throbbing or pulsating pain lasting 4 to 72 hours.
Four weeks after the use of high-dose intravenous glucocorticosteroid, 28.2% reported slight headache improvements, 25.6% reported substantial headache improvements, and 20.5% reported complete headache improvement. The reduction in headaches is thought to be associated with immunomodulatory therapy.
Future research needs to analyze the relationship between inflammatory activities and headaches and a pathophysiologic link between MS and headaches.
In conclusion, the researchers found a high frequency and a high prevalence of headaches at the onset of MS symptoms that decreased significantly 6 months post diagnosis. Treating headaches as an early indicative symptom of MS could help “enable an early treatment, which is important to halt the progression of the disease.”
Gebhardt M, Kropp P, Hoffmann F, Zettl UK. Headache at the time of first symptom manifestation of multiple sclerosis: a prospective, longitudinal study. Eur Neurol. 2018; 80(3-4):115-120.