Friday, March 1, 2013

Vascular Headache and MS


This is from an AAN presentation made in 2010, Migraine More Common in Women with MS-
The study involved 116,678 women who were part of the Nurses’ Health Study II. Of these women, 18,000 had been diagnosed with migraine at the start of the study. The women were followed every two years for 16 years. During the study, 375 women were diagnosed with MS. Of those, 82 had reported at the beginning of the study that they had been diagnosed by a doctor with migraine.

The study found that women with a migraine diagnosis at the beginning of the study were 47 percent more likely to develop MS than women without a diagnosis. The results were the same regardless of age, where they lived, Scandinavian ancestry, vitamin D levels, smoking status and body mass index.
The research represents the first large scale study of its kind to explore the relationship between migraine and MS.

A medical blogger with MS writes about the research.

According to the migraine/multiple sclerosis (MS) study, women with migraine headaches may be nearly 50 percent more likely to develop multiple sclerosis (MS) than those without them.

This announcement seems to clarify and affirm what countless female multiple sclerosis (MS) patients have known from personal experience, but without medical confirmation, for decades.

Traditionally, physicians have been somewhat reticent to confirm any possible link between migraine headaches and the demyelinating neurological disease known as multiple sclerosis (MS). Migraines, after all, are classified as vascular headaches, rather than a neurological condition.

"Vascular or migraine type headaches have even been reported as the first symptom of MS," the National Multiple Sclerosis Society has said.


Here is a meta-analysis from 2012, which looked at 1,864 MS patients and 261,563 normals.

We found a significant association between migraine and MS (OR = 2.60, 95% CI 1.12–6.04)
MS patients are more than twice as likely to report migraine as controls. Care providers should be alerted to ask MS patients about migraine in order to treat it and potentially improve quality of life. Future work should further investigate the temporal relationship of this association and relationship to the clinical characteristics of MS.


In 1952 Compston and McAlpine found that 2% of MS sufferers experienced migraine within 3 months of MS onset.
Q J Med. 1952 Apr;21(82):135-67. Some aspects of the natural history of disseminated sclerosis.
McALPINE D, COMPSTON N.

Here is one curious young neurologist, who, in 1989, took the research from the 1950s and noted that vascular headache was a presenting symptom of MS.  (He is now one of the most vocal detractors against CCSVI, calling it a hoax.)

Dr. Mark Freedman's abstract--

Vascular headache of migraine-type may be a presenting symptom of multiple sclerosis (MS), a condition usually not considered in the differential diagnosis of a severe headache accompanied by neurological signs. We reviewed records of 1,113 patients with MS seen from 1967-1987 and found 44 cases whose initial attack or subsequent exacerbations were heralded by a migraine-type headache. Twenty-seven patients had no prior history of migraine, and of these, 12 presented simultaneously with their first headache and MS attack. Twenty-three patients had symptoms of a posterior fossa mass lesion. The significance of these results and possible pathogenesis is discussed.

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Migraine is a known vascular condition.  The pain of migraine comes from the abnormal functioning of the brain's blood vessels.  Migraine is also associated with white matter lesions in the brain.  And yes, MS researchers have been "reticent" to comment on this very direct link of the vasculature and MS.

There is a vascular connection to MS.  Neurologists and MS researchers know it.  What they choose to do with this information is another matter.
Joan


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