COMORBID PRIMARY HEADACHE: OCCURANCE AND PREVALENCE IN PATIENTS WITH RELAPSING REMITTING MULTIPLE SCLEROSIS
Authors: Andriievska M. I. 
Published: October 2022

Multiple sclerosis (MS) is an autoimmune progressive disease of the nervous system based on the demyelization of nerve fibers, belongs to the group of chronic disabling diseases that most often affects young people who are actively able to work. The prognosis of MS depends on the course of disease and presence of comorbidity. One of the most common comorbid conditions in MS is headache. The connection between MS and primary headache has long been known. The comorbidity of headaches and MS is poorly understood. Relapsing remitting multiple sclerosis (RRMS) is a type of MS which is characterized of periods of active clinical symptoms and phases of remission. RRMS is the most frequent variant of the course of MS.
Objective: to describe the prevalence and structure of primary headache comorbidity in patients with RRMS, to show the frequency of different types of primary headache among patients with RRMS, to find gender correlations between presence of headache and MS, to determine the duration, frequency, intensity of headache and presence of chronic headache, to analyze social history.
Material and methods. 46 patients with RRMS were examined. Structure of the primary headache was determined according to the criteria of ICHD-3. The intensity of the headache was measured using the VAS - Visual Analogue Scale. Statistical processing of the obtained results was performed in the SPSS program.
Results. Patients were randomized in two clinical groups depending on the presence of primary headache: 19 patients - with presence of comorbid headache, 27 – without any comorbidity The average age of respondents with and without comorbid headache was 35.79 and 31.52 years respectively. Gender status was the following: 16 males and 36 females. 22 patients were married, 19 patients were single, and 5 patients were divorced. The prevalence of comorbid headache was higher in females among examined patients. The duration of the RRMS disease from the moment of the first symptom in the examined groups of patients was 7.43±5.218 years. The average duration of headache is 10.05 years. Structure of the primary headache was the next: 13 patients – migraine, 5 patients - migraine with aura, 6 patients - tension type headache. Patients with autonomic cephalgia or cluster headache have not been identified. 12 patients noted the appearance of pain before the diagnosis of RRMS. In 7 patients the headache began after the diagnosis of MS. The average frequency of headache in patients was 8.68 days per month, the intensity of headache according to the VAS was 6.11 points – middle intensity. Chronic headache was observed in 7 patients, 12 patients had episodic headache. 10 patients found that headache impaired daily activity, 7 patients noted that headache provoked excessive fatigue and required additional rest, and 13 patients noted that headache reduced concentration. Along with frequent motor dysfunction in MS, patients experience limited daily activity due to the comorbid headache.
Conclusion. Comorbid headache in RRMS has a significant negative impact on the functioning and quality of life of patients, thus, cannot be ignored. The frequency of headache is about half of patients with RRMS. Migraine predominates in the structure of comorbid headache in RRMS. The majority of patients noted the appearance of headache before the first symptoms of MS. The question of whether headache is a risk factor for MS and one of the symptoms of exacerbation in RRMS remains unresolved.
Multiple sclerosis (MS) is an autoimmune progressive disease of the nervous system based on the demyelization of nerve fibers, belongs to the group of chronic disabling diseases that most often affects young people who are actively able to work. The prognosis of MS depends on the course of disease and presence of comorbidity. One of the most common comorbid conditions in MS is headache. The connection between MS and primary headache has long been known. The comorbidity of headaches and MS is poorly understood. Relapsing remitting multiple sclerosis (RRMS) is a type of MS which is characterized of periods of active clinical symptoms and phases of remission. RRMS is the most frequent variant of the course of MS.
Objective: to describe the prevalence and structure of primary headache comorbidity in patients with RRMS, to show the frequency of different types of primary headache among patients with RRMS, to find gender correlations between presence of headache and MS, to determine the duration, frequency, intensity of headache and presence of chronic headache, to analyze social history.
Material and methods. 46 patients with RRMS were examined. Structure of the primary headache was determined according to the criteria of ICHD-3. The intensity of the headache was measured using the VAS - Visual Analogue Scale. Statistical processing of the obtained results was performed in the SPSS program.
Results. Patients were randomized in two clinical groups depending on the presence of primary headache: 19 patients - with presence of comorbid headache, 27 – without any comorbidity The average age of respondents with and without comorbid headache was 35.79 and 31.52 years respectively. Gender status was the following: 16 males and 36 females. 22 patients were married, 19 patients were single, and 5 patients were divorced. The prevalence of comorbid headache was higher in females among examined patients. The duration of the RRMS disease from the moment of the first symptom in the examined groups of patients was 7.43±5.218 years. The average duration of headache is 10.05 years. Structure of the primary headache was the next: 13 patients – migraine, 5 patients - migraine with aura, 6 patients - tension type headache. Patients with autonomic cephalgia or cluster headache have not been identified. 12 patients noted the appearance of pain before the diagnosis of RRMS. In 7 patients the headache began after the diagnosis of MS. The average frequency of headache in patients was 8.68 days per month, the intensity of headache according to the VAS was 6.11 points – middle intensity. Chronic headache was observed in 7 patients, 12 patients had episodic headache. 10 patients found that headache impaired daily activity, 7 patients noted that headache provoked excessive fatigue and required additional rest, and 13 patients noted that headache reduced concentration. Along with frequent motor dysfunction in MS, patients experience limited daily activity due to the comorbid headache.
Conclusion. Comorbid headache in RRMS has a significant negative impact on the functioning and quality of life of patients, thus, cannot be ignored. The frequency of headache is about half of patients with RRMS. Migraine predominates in the structure of comorbid headache in RRMS. The majority of patients noted the appearance of headache before the first symptoms of MS. The question of whether headache is a risk factor for MS and one of the symptoms of exacerbation in RRMS remains unresolved.