Headache in the first manifestation of Multiple Sclerosis – Prospective, multicenter study

OBJECTIVES: Multiple sclerosis (MS) is the most frequent immune‐mediated inflammation of the central nervous system that can lead to early disability. Headaches have not been considered as MS‐related symptoms initially, whereas higher prevalence rates were reported since 2000. Postmortem histological analyses of MS patients’ brains revealed lymphoid follicle‐like structures in the cerebral meninges which suggest a possible pathophysiological explanation for the high headache prevalence in MS. The aim of this study was to evaluate headache characteristics during the first clinical event of MS. METHODS: In a prospective, multicenter study, 50 patients with the diagnosis of CIS or MS were recruited. All participants were screened for the presence of headache within the last 4 weeks with help of the Rostock Headache Questionnaire (Rokoko). RESULTS: Thirty‐nine of fifty questioned patients (78%) reported headaches within the last 4 weeks. Most patients suffered from throbbing and pulsating headaches (25, 50%), 15 (30%) reported stabbing, 14 (28%) dull and constrictive headaches. CONCLUSIONS: Headaches were prevalent in 78% of patients in our population with newly diagnosed CIS and MS. It is among the highest prevalence rates reported so far in patients with CIS or MS. Thus, headache, especially of a migraneous subtype, is a frequent symptom within the scope of the first manifestation of multiple sclerosis. If it were possible to define a MS‐typical headache, patients with these headaches and with typical MRI results would be classified as CIS or early MS instead of radiologically isolated syndrome and treated accordingly with an immunomodulatory therapy.