Primary Headaches Prevalent in MS, Research Reveals

The prevalence of primary headaches — those with no clear cause — is high among patients with multiple sclerosis (MS), a new study suggests.

Clinical screening of headache among MS patients could help tailor individualized treatments and ease the impact of the disease for these patients.

The study, “The epidemiology of primary headaches in patients with multiple sclerosis,” was published in the journal Brain and Behavior.

Primary headaches refer to headaches with a lack of clear underlying structural pathology, trauma, or systemic disease. These include both migraine and tension-type headaches.

Headache is a common neurological condition reported among people with MS. However, the prevalence of primary headaches among MS patients differs substantially across studies — ranging from 35.5% to 70%.

To shed light on this matter, researchers at The First Affiliated Hospital of Anhui Medical University, in China, estimated the prevalence of primary headache among patients with MS through a systematic review and meta-analysis — examination of data from a number of independent studies in order to determine overall trends.

Through a systematic literature search, the team identified 62 studies that met the defined inclusion criteria. From these, 16 full-text research articles were included in the final qualitative and quantitative analysis.

These studies covered a total of 3,560 MS patients (72% female, mean age ranging from 30.0 to 50.7 years across studies), from seven case‐control studies and nine cross‐sectional studies mostly conducted in Europe and North America.

For classification of primary headache among patients with MS, migraine and tension‐type headache were evaluated in all 16 studies, while migraine with or without aura were evaluated in five studies.

The overall prevalence of primary headaches among patients with MS was considerably high (55%). However, there was a moderate heterogeneity (variability) among studies included in the meta-analysis, ranging from 41% to 67%.

The estimated prevalence of migraine headache (30%) was higher in comparison with that of tension‐type headache (22%). The prevalence of migraine without aura was 16% and 10% for migraine with aura.

Although the prevalence of primary headaches was slightly higher in the case–control group (57%) than in the cross‐sectional group (53%), statistical analysis revealed no significant publication bias.

The overall prevalence of primary headaches among patients with MS did not differ from patients in Asian and European countries (about 55%). However, researchers found a high heterogeneity in the prevalence of headaches in patients from Asian countries compared to European countries. Researchers believe this heterogeneity may be due, in part, to geographical differences.

Researchers noted several limitations to their study. The majority of the included studies were from European countries, which may decrease the accuracy of estimation. Also, due to absence of adequate information, researchers did not investigate ethnicity data. Finally, the fact that non-standardized data collection tools were used in some studies may have affected the pooled prevalence of primary headaches.

Nonetheless, the researchers concluded the results indicate “the overall prevalence of primary headaches among patients with MS was considerably high,” and suggested that “clinical screening of headache among patients with MS will be helpful to formulate an individualized treatment plans and alleviate the physical and mental impact of the disease.”