Skip to main content

Advertisement

SpringerLink
Log in

Tension-type Headache and Migraine in Multiple Sclerosis

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

We review the evidence for a link between multiple sclerosis (MS) and two of the most common primary headache disorders: tension-type headache and migraine. We argue that the association between migraine and MS is biologically plausible and is confirmed by most studies. We discuss possible explanations for the association. First, we consider the possibility that the association is spurious. Next, we consider unidirectional causal models in which one of the conditions increases the risk of the other. A bidirectional model would suggest that each disease predisposes to the other. Alternatively, genetic or environmental risk factors shared by each condition may account for the association between them. We also address the question of whether coexisting migraine or tension-type headache in a patient with MS affects the symptom profile, clinical course, and radiographic characteristics of MS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Scher AI, Stewart WF, Lipton RB: The comorbidity of headache with other pain syndromes. Headache 2006, 46:1416–1423.

    Article  PubMed  Google Scholar 

  2. Breslau N, Lipton RB, Stewart WF, et al.: Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology 2003, 60:1308–1312.

    CAS  PubMed  Google Scholar 

  3. Paparrigopoulos T, Ferentinos P, Kouzoupis A, et al.: The neuropsychiatry of multiple sclerosis: focus on disorders of mood, affect and behavior. Int Rev Psychiatry 2010, 22:14–21.

    Article  PubMed  Google Scholar 

  4. • O’Connor AB, Schwid SR, Herrmann DN, et al.: Pain associated with multiple sclerosis: Systematic review and proposed classification. Pain 2008, 137:96–111. This otherwise outstanding review of pain syndromes in MS does not do justice to the subject of headache.

    Article  PubMed  Google Scholar 

  5. Alstadhaug K, Breivik K, Rusic Z: Recurrent headache due to MS plaque. Headache 2008, 48:453–454.

    Article  PubMed  Google Scholar 

  6. Davey R, Al-Din A: Secondary trigeminal autonomic cephalgia associated with multiple sclerosis. Cephalalgia 2004, 24:605–607.

    Article  CAS  PubMed  Google Scholar 

  7. Haas DC, Kent PF, Friedman DI: Headache caused by a single lesion of multiple sclerosis in the periaqueductal gray area. Headache 1993, 33:452–455.

    Article  CAS  PubMed  Google Scholar 

  8. Elliott DG. Migraine in multiple sclerosis. Int Rev Neurobiol 2007, 79:281–302.

    Article  CAS  PubMed  Google Scholar 

  9. Schwartz BS, Stewart WK, Simon D, Lipton RB: Epidemiology of tension-type headache. JAMA 1998, 279:381–383.

    Article  CAS  PubMed  Google Scholar 

  10. D’Amico D, La Mantia L, Rigamonti A, et al.: Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia 2004, 24:980–984.

    Article  PubMed  Google Scholar 

  11. • Nicoletti A, Patti F, Lo Fermo S, et al.: Headache and multiple sclerosis: a population-based case–control study in Catania, Sicily. Cephalalgia 2008, 28:1163–1169. This population-based study of headache in MS surveyed more than two thirds of all known multiple sclerosis cases in Sicily. It provides support for the idea that the association between headache and multiple sclerosis extends to MS patients at large, and not only to those who attend specialized clinics.

    Article  CAS  PubMed  Google Scholar 

  12. • Putzki N, Pfriem A, Limmroth V, et al.: Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis. Eur J Neurol 2009, 16:262–267. This large prospective study of MS outpatients and historical control patients showed higher prevalence of migraine in the general population compared to patients with MS, though the prevalence of primary headaches in healthy controls was much higher than expected.

    Article  CAS  PubMed  Google Scholar 

  13. Monaldini C, Capone JG, Caniatti ML, et al.: Headache in Multiple Sclerosis. Clinical and Therapeutical Correlations [poster P04.190]. Presented at the American Academy of Neurology Annual Meeting. Toronto, Canada; April 10–17, 2010.

  14. • Boneschi FM, Colombo B, Annovazzi P, et al.: Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 2008, 14:514–521. This cross-sectional study shows the actual and lifetime prevalence of pain (neuropathic or somatic) and headache in patients with MS and sought to identify predictive demographic and disease-related factors for an increased risk of specific types of pain and headache.

    Article  PubMed  Google Scholar 

  15. Rolak LA, Brown S: Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol 1990, 237:300–302.

    Article  CAS  PubMed  Google Scholar 

  16. Pöllmann W, Erasmus LP, Feneberg W, et al.: Interferon beta but not glatiramer acetate therapy aggravates headaches in MS. Neurology 2002, 59:636–639.

    PubMed  Google Scholar 

  17. Villani V, Prosperini L, Ciuffoli A, et al.: Primary headache and multiple sclerosis: preliminary results of a prospective study. Neurol Sci 2008, 29(Suppl 1):S146–S148.

    Article  PubMed  Google Scholar 

  18. • Kister I, Caminero AB, Monteith TS, et al.: Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 13 July 2010 (Epub ahead of print). This clinic-based study by the authors of this review is the only study to compare clinical and radiographic features of patients with MS and migraine v. headache-free patients with MS.

  19. Merikangas KR, Angst J, Isler H: Migraine and psychopathology. Results of the Zurich cohort study of young adults. Arch Gen Psychiatry 1990, 47:849–853.

    CAS  PubMed  Google Scholar 

  20. Swartz KL, Pratt LA, Armenian HK, et al.: Mental disorders and the incidence of migraine headaches in a community sample: results from the Baltimore Epidemiologic Catchment area follow-up study. Arch Gen Psychiatry 2000, 57:945–950.

    Article  CAS  PubMed  Google Scholar 

  21. Mitsonis CI, Potagas C, Zervas I, Sfagos K: The effects of stressful life events on the course of multiple sclerosis: a review. Int J Neurosci 2009, 119:315–335.

    Article  PubMed  Google Scholar 

  22. Holroyd KA, France JL, Nash JM, Hursey KG: Pain state as artifact in psychological assessment of recurrent headache sufferers. Pain 1993, 53:229–235.

    Article  CAS  PubMed  Google Scholar 

  23. Ergün U, Ozer G, Sekercan S, et al.: Headaches in the different phases of relapsing-remitting multiple sclerosis: a tendency for stabbing headaches during relapses. Neurologist 2009, 15:212–216.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Libera DD, Colombo B, Sebastioano B, et al.: One-Year Prospective Study on Headache Occurrence in Multiple Sclerosis (MS) Patients Treated with Natalizumab [poster P01.195]. Presented at the American Academy of Neurology Annual Meeting. Toronto, Canada; April 10–17, 2010.

  26. Pöllmann W, Erasmus LP, Feneberg W, Straube A: The effect of glatiramer acetate treatment on pre-existing headaches in patients with MS. Neurology 2006, 66:275–277.

    Article  PubMed  Google Scholar 

  27. Compston N, McAlpine D: Some aspects of the natural history of disseminated sclerosis. Q J Med 1952, 21:135–167.

    PubMed  Google Scholar 

  28. Freedman MS, Gray TA: Vascular headache: a presenting symptom of multiple sclerosis. Can J Neurol Sci 1989, 16:63–66.

    CAS  PubMed  Google Scholar 

  29. Watkins SM, Espir M: Migraine and multiple sclerosis. J Neurol Neurosurg Psychiatry 1969, 32:35–37.

    Article  CAS  PubMed  Google Scholar 

  30. Filippini G, Munari L, Incorvaia B, et al.: Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet 2003, 361:545–552.

    Article  CAS  PubMed  Google Scholar 

  31. La Mantia L, D’Amico D, Rigamonti A, et al.: Interferon treatment may trigger primary headaches in multiple sclerosis patients. Mult Scler 2006; 12:476–480.

    Article  PubMed  Google Scholar 

  32. Martínez Sobrepera HJ, Cabrera Gómez JA, Tuero Iglesias A: Exogenous factors in the aetiology of multiple sclerosis in Cuba. A study of cases and controls [in Spanish]. Rev Neurol 2001, 33:931–937.

    PubMed  Google Scholar 

  33. Doi H, Matsushita T, Isobe N, et al.: Frequency of chronic headaches in Japanese patients with multiple sclerosis: with special reference to opticospinal and common forms of multiple sclerosis. Headache 2009, 49:1513–1520.

    Article  PubMed  Google Scholar 

  34. Kister I, Munger K, Herbert J, Ascherio A: Increased Risk of Multiple Sclerosis among Women with Migraine in the Nurses’ Health Study II [poster P01.172]. Presented at the American Academy of Neurology Annual Meeting. Toronto, Canada; April 10–17, 2010.

  35. Zorzon M, Zivadinov R, Nasuelli D, et al.: Risk factors of multiple sclerosis: a case-control study. Neurol Sci 2003, 24:242–247.

    Article  CAS  PubMed  Google Scholar 

  36. Vacca G, Marano E, Brescia Morra V, et al.: Multiple sclerosis and headache co-morbidity. A case-control study. Neurol Sci 2007, 28:133–135.

    Article  CAS  PubMed  Google Scholar 

  37. Warren S, Warren KG: Multiple sclerosis and associated diseases: a relationship to diabetes mellitus. Can J Neurol Sci 1981, 8:35–39.

    CAS  PubMed  Google Scholar 

  38. Lipton RB, Scher AI, Kolodner K, et al.: Migraine in the United States: epidemiology and patterns of health care use. Neurology 2002, 58:885–894.

    CAS  PubMed  Google Scholar 

  39. Fragoso YD, Brooks JB: Two cases of lesions in brainstem in multiple sclerosis and refractory migraine. Headache 2007, 47:852–854.

    Article  PubMed  Google Scholar 

  40. Tortorella P, Rocca MA, Colombo B, et al.: Assessment of MRI abnormalities of the brainstem from patients with migraine and multiple sclerosis. J Neurol Sci 2006, 244:137–141.

    Article  PubMed  Google Scholar 

  41. Gursoy-Ozdemir Y, Qiu J, Matsuoka N, et al.: Cortical spreading depression activates and upregulates MMP-9. J Clin Invest 2004, 113:1447–1455.

    CAS  PubMed  Google Scholar 

  42. Stewart WF, Lipton RB, Liberman J: Variation in migraine prevalence by race. Neurology 1996, 47:52–59.

    CAS  PubMed  Google Scholar 

  43. Noonan CW, Kathman SJ, White MC: Prevalence estimates for MS in the United States and evidence of an increasing trend for women. Neurology 2002, 58:136–138.

    PubMed  Google Scholar 

  44. Ascherio A, Munger KL: Environmental risk factors for multiple sclerosis. Part I: the role of infection. Ann Neurol 2007, 61:288–299.

    Google Scholar 

  45. • Marrie RA, Horwitz R, Cutter G, et al.: Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology 2009, 72:117–124. This analysis of one of the largest MS datasets, the North American Research Committee of Multiple Sclerosis (NARCOMS) registry, demonstrated detrimental effect of various comorbidities on time to diagnosis of MS and on rate of disability accumulation.

    Article  CAS  PubMed  Google Scholar 

  46. Buchanan RJ, Wang S, Tai-Seale M, Ju H: Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set. Mult Scler 2003, 9:171–188.

    Article  PubMed  Google Scholar 

  47. Burstein R, Yarnitsky D, Goor-Aryeh I, et al.: An association between migraine and cutaneous allodynia. Ann Neurol 2000, 47:614–624.

    Article  CAS  PubMed  Google Scholar 

  48. Kitaj MB, Klink M: Pain thresholds in daily transformed migraine versus episodic migraine headache patients. Headache 2005, 45:992–998.

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors wish to thank Ms. Tamar Bacon for her help in preparation of this manuscript.

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Neurology, NYU School of Medicine, Multiple Sclerosis Care Center, 301 East 17th Street, New York, NY, 10003, USA

    Ilya Kister & Joseph Herbert

  2. Department of Neurology, Hospital Nuestra Señora de Sonsoles, Ávila, Spain

    Ana B. Caminero

  3. Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, New York, NY, 10461, USA

    Richard B. Lipton

Authors
  1. Ilya Kister
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana B. Caminero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph Herbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard B. Lipton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilya Kister.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kister, I., Caminero, A.B., Herbert, J. et al. Tension-type Headache and Migraine in Multiple Sclerosis. Curr Pain Headache Rep 14, 441–448 (2010). https://doi.org/10.1007/s11916-010-0143-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-010-0143-5

Keywords

Search

Navigation