Features of Primary Forms of Headache in Multiple Sclerosis

Objective. To study the characteristics of types of primary headache (HA) in patients with confirmed diagnoses of multiple sclerosis (MS). Materials and methods. During the period from April 1, 2023 to May 31, 2023, a total of 110 patients with MS were examined at the outpatient clinic of a neurologist in the Department of Neurology and Neurosurgery, Smolensk State Medical University, Ministry of Health of the Russian Federation, and a group of 20 people with diagnoses of primary HA was selected. At the same time, a reference group of 20 people with diagnoses of primary HA was formed at the Center for Industrial Medicine, Medical Sanitary Unit No. 135, Federal Medical and Biological Agency of Russia, Desnogorsk. Patients were assessed by analysis of complaints, histories, laboratory data, neurological status, and test results on specialist scales. Results. Migraine was the most common type of HA in patients with MS (at a ratio of 5.6:1 as compared with tension HA) and was observed in 17 MS patients (85%). Tension HA was diagnosed in only three (15%) patients (p = 0.002). Headache was statistically more common in the relapsing-remitting form of MS (p = 0.046). Age, total cholesterol level, EDSS, and type of therapy with disease-modifying drugs were not associated with the risk of developing HA. Comparison of the population of patients with MS and primary HA with the reference group revealed statistically signif0069cant differences on the anxiety and depression scale and the Montreal Cognitive Assessment (MoCA). Conclusions. The results obtained here indicate that primary HA were diagnosed in 18.2% of MS patients receiving disease-modifying drugs, with the prevalence of migraine being much higher than that of tension HA. In addition, female sex and the type of MS course were significantly associated with the risk of developing migraine. Migraine as a comorbid condition may worsen cognitive impairment in patients with MS, producing lower MoCA scores, especially on the background of progression of anxious and depressive disorders. These findings suggest the need for a larger epidemiological study to provide an accurate estimation of the prevalence of primary HA in patients with MS in the Smolensk region.