Headache and multiple sclerosis

This review reports about the association of multiple sclerosis (MS) and migraine, tension type headache, trigeminal neuralgia, and headache induced by immunomodulatory therapy. The prevalence of migraine in patients with MS is between 20 and 45% and differs due to regional variations, sex and the kind of immunomodulatory therapy. According to several studies, especially migraine with aura seems to be a risk factor for the occurrence of MS and a predictor for an early manifestation of MS. The prevalence of tension type headache seems to be not increased in patients with MS. Headache occurs five times more often under a therapy with beta-interferon than with glatiramer acetate. A short intake of analgesics can improve the immunotherapy related headache. A trigeminal neuralgia is three times more often in MS patients and is in up to 18% of the patients with trigeminal neuralgia and MS bilateral and often due to a symptomatic brain stem lesion. In conclusion, the existing data of the association of MS and headache are still incomplete, therefore larger population based studies with control of confounder effects are required.