Headaches are a common symptom in multiple sclerosis (MS) patients, occurring in 55.6-68% of cases. The most common types of headaches seen in MS are migraine-like headaches, tension headaches, and primary stabbing headaches. Headaches can sometimes be one of the initial presenting symptoms of MS or can occur during disease relapses. Treatment of MS-related headaches may involve pulse steroid therapy or other analgesics, which can help improve headache symptoms within a few days.

1. HEADACHE IN MULTIPLE
SCLEROSIS
Ade Wijaya, MD – October 2022

2. Introduction
 Multiple sclerosis (MS) is a chronic demyelinating
disease of unknown etiology which is
characterized by relapses and predominantly
affects women in the second or the third decade
of life
 MS relapses may occur with visual disturbances,
motor and sensory involvement, or cerebellar or
spinal involvement. Initial and relapse symptoms
of MS may include acute brachial pain, sore
throat, hypoglossal nerve palsy, epileptic seizures,
and headache
Gökhan, Ö. Z. E. R., Ergün, U., & İnan, L. E. (2018). Headache in Multiple Sclerosis from A Different Perspective: A Prospective Study. Journal of Clinical and Experimental

4. Headache in MS
 Overall prevalence: 55.6-68 %
 Migraine-like headache: 14-16.7 %
 Tension type headache: 16-31.9 %
 Cluster headache: 0.8 %
 Primary stabbing headache: 11-18 %
 Mixed type headache: 13-22 %
 Unclassified headache: 8.6 %
Gökhan, Ö. Z. E. R., Ergün, U., & İnan, L. E. (2018). Headache in Multiple Sclerosis from A Different Perspective: A Prospective Study. Journal of Clinical and Experimental

5. Headache in MS
 13 % as presenting symptoms
 Pulse steroid therapy for 3 to 5 days
 Headache symptoms improved partially or
completely in 3 to 10 days
Gökhan, Ö. Z. E. R., Ergün, U., & İnan, L. E. (2018). Headache in Multiple Sclerosis from A Different Perspective: A Prospective Study. Journal of Clinical and Experimental

6. Pathophysiology
 Increased cytokine synthesis and specifically
IL-10, an anti-inflammatory cytokine
Gökhan, Ö. Z. E. R., Ergün, U., & İnan, L. E. (2018). Headache in Multiple Sclerosis from A Different Perspective: A Prospective Study. Journal of Clinical and Experimental
Munno I, Marinaro M, Bassi A et al. Immunological aspects in migraine: increase of IL-10 plasma levels during attack. Headache. 2001;41:764–7
Beebe AM, Cua DJ, de Waal Malefyt R The role of interleukin-10 in autoimmune disease: systemic lupus erythematosus (SLE) and multiple sclerosis (MS). Cytokine Growth Factor Rev.
2002;13:403–12.

7. Summary
 Headache is common in MS patients
 Can be as presenting or relaps symptoms
 Treatment: steroids and other analgesics

8. THANK YOU