http://neurology.medscape.com/Medscape/Neurology/AskExperts/MS/2001/10/NEUR-ae99.html
Question
Is multiple sclerosis (MS) in and
of itself ever an etiology for headache? If so, what is the pathophysiology
and reasonable treatment?
Response
MS is commonly associated with headaches,
with a prevalence of approximately 12% to 52%. Sometimes, the headaches
are associated with specific brain lesions seen on MRI, such as large,
supratentorial, tumorlike plaques or lesions in the pons. However, in most
cases, the headaches are present without predictable MRI correlations.
Patients with MS may also develop
headaches during bouts of optic neuritis. These are typically unilateral
and worsened by eye movement. Other causes for headaches in MS patients
are cervical paraspinal spasm (tension headache), migraine, or depression.
There is no evidence indicating that headaches in patients with MS require
treatment different from that for similar headache syndromes not associated
with MS. In my experience, most patients respond to nonsteroidal anti-inflammatory
agents or antidepressants and migraine-specific agents, if indicated. In
selected cases, referral to a pain specialist may be helpful.
Suggested Reading
Bakshi R, Glass J, Louis DN, Hochberg
FH. Magnetic resonance imaging features of solitary inflammatory brain
masses. J Neuroimaging. 1998;8:8-14.
Kramer R. Treatment of chronic pain.
In: Rudick RA, Goodkin DE, eds. Multiple Sclerosis Therapeutics. London:
Martin Dunitz; 1999:541-546.
Matthews WB, Compston A, Allen IV,
Martyn CN. McAlpine's Multiple Sclerosis. New York: Churchill Livingstone;
1992:71.
Paty DW, Ebers GC. Clinical features.
In: Paty DW, Ebers GC, eds. Multiple Sclerosis. Philadelphia: FA Davis;
1998:135-191.
Rolak LA, Brown S. Headaches and
multiple sclerosis: a clinical study and review of the literature. J Neurol.
1990;237:300-302.
from Rohit Bakshi, MD, 10/30/01