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Migraine - Patient focus

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PUBLICATION PULSE: Quantifying the relationship between migraine and multiple sclerosis

Mirmosayyeb O, Barzegar M, Nehzat N, Shaygannejad V, Sahraian MA, Ghajarzadeh M. The prevalence of migraine in multiple sclerosis (MS): A systematic review and meta-analysis. J Clin Neurosci 2020;79:33–8.

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The lead-up

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system and is characterized by myelin loss and progressive neurological dysfunction.1 MS is the leading cause of nontraumatic neurological disability.1 The disease is often accompanied by pain, which 40%–65% of MS patients experience.2 Although headache is not generally considered to be a symptom of MS, some studies have reported an association between migraine and MS, though the extent of this relationship is up for debate.3 The reported prevalence of migraine or headache in MS varies widely from as low as 4% to as high as 69%.3,4  Mirmosayyeb and colleagues performed a systematic literature review in order to estimate the pooled prevalence of migraine in MS and better explain the relationship between the two diseases.

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The approach

The authors searched several databases, including PubMed and Scopus, for cross-sectional studies evaluating the prevalence of migraine in patients with MS. The search strategy used medical subject heading (MeSH) terms as well as several keywords related to migraine, MS and headache. Once the articles were identified, they were assessed by two independent researchers, who extracted the relevant data from the studies. Statistical analyses were then performed in order to find and verify the pooled prevalence of migraine in MS.

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The findings

In total, 1,500 unique articles were found from the literature search. 11,372 MS cases and 2,627 patients with migraine were included in the analysis. From this analysis, the pooled prevalence of migraine in MS from available literature was found to be 31% (p<0.001). As expected, there was a wide range of prevalence numbers reported, ranging from 2% to 67%. Additionally, the numbers varied in different parts of the world. The pooled prevalence was 24% in Asian countries, 43% in North and South American countries, 25% in European countries, and 43% in African countries.

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The scrutiny

This literature review is the product of research done all over the world in thousands of MS patients. The results showed that in different parts of the world and in different societies, there is varying prevalence of migraine in MS and a breadth of patient experiences.

For example, one study that was included in the analysis was a Brazilian study that assessed 746 MS patients and found that 54.1% of them were diagnosed with migraine.5 In this study, 69.9% of patients had moderate or severe pain as a result of headache and 21.1% had more than 15 headache days per month.5 In contrast, an Italian study reported the prevalence of migraine to be 25% in 137 MS patients.3 This study also found that migraine was more prevalent in relapsing-remitting MS than in progressive MS.3 A look at studies in other parts of the world continues to deliver mixed results; prevalence rates were found by individual studies to be 27% in Iran, 12% in Norway, 8% in France and 12% in the United States.

In addition to migraine being prevalent in MS patients, there is an increased risk of MS in patients with a history of migraine, which may point to a bidirectional relationship between the two diseases.6 One possible explanation for the association between migraine, specifically migraine with aura, and MS is that there is a depression of the cortex in migraine with aura.6 This leads to an increase in the permeability of the blood–brain barrier which would predispose the myelin of neurons to T cells, leading to the characteristic dysfunction of the CNS in MS.6

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The next questions

  • Is there a relationship between MS and migraine at the genetic level?
  • Is the increased prevalence for both diseases among women evidence of a genetic association? What is the extent of the effect of hormones on MS?  
  • Does the presence of MS in migraine worsen other comorbid conditions associated with migraine?
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The bottom line

In this systematic literature review, 1,500 cross-sectional studies were analyzed to estimate the total pooled prevalence of migraine in patients with MS, which was found to be 31%. This prevalence, however, varied greatly, especially in different continents. There is still debate about the relationship between MS and migraine, which could be made clear by future research into the genetic and hormonal nature of each disease.

References

  1. Hauser SL, Cree BAC. Treatment of Multiple Sclerosis: A Review. Am J Med 2020;0.

  2. Ghajarzadeh M, Jaililan R, Sahraian MA, et al. Pain in Patients with Multiple Sclerosis. Maedica 2018;13:125–30.

  3. D'Amico D, La Mantia L, Usai S, Mascoli N, Milanese C, Bussone G. Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia 2004;24:980–4.

  4. Kister I, Caminero AB, Herbert J, Lipton RB. Tension-type Headache and Migraine in Multiple Sclerosis. Curr Pain Headache Rep 2010;14:441–8.

  5. Fragoso YD, Adoni T, Alves-Leon SV, et al. Migraine in 746 patients with multiple sclerosis. Arq Neuropsiquiatr 2019;77:617–21.

  6. Kister I, Munger KL, Herbert J, Ascherio A. Increased Risk of Multiple Sclerosis among Women with Migraine in the Nurses’ Health Study II. Mult Scler 2012;18:90–7.

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