Document Type : Original Article
Authors
1 Multiple Sclerosis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD.
Methods: This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3).
Results: Eighteen patients (15%) reported headaches, all of whom were women. The average age of these patients was 41.27 ± 11.33 years, and the average onset age of NMOSD was 34.60 ± 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 ± 1.42) than those with tension headaches (4.20 ± 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis.
Significant associated symptoms included photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57% of migraine sufferers and 50% of tension headache sufferers.
Conclusion: Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.
Keywords
- Neuromyelitis Optica
- Autoimmunity
- Inflammation
- Optic Neuritis
- Transverse Myelitis
- Headache
- Migraine Disorders
- Tension-Type Headache
- Disability
Main Subjects
- Jarius S, Wildemann B, Paul F. Neuromyelitis optica: Clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014; 176(2): 149-64.
- Orphanet: Neuromyelitis optica spectrum disorder [Online]. [cited 2024 May 25]; Available from: URL: https://www.orpha.net/en/disease/detail/71211. 2024.
- Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85(2): 177-89.
- Ranjan A, Mudassir S, Sinha N, Panjwani A, Kumar A. Area postrema syndrome: an initial presentation of double-seropositive AQP4 and MOG antibodies. Neurol Clin Pract 2022; 12(4): e82-e84.
- Kremer L, Mealy M, Jacob A, Nakashima I, Cabre P, Bigi S, et al. Brainstem manifestations in neuromyelitis optica: A multicenter study of 258 patients. Mult Scler 2014; 20(7): 843-7.
- Etemadifar M, Nouri H, Khorvash R, Salari M, Ghafari K, Aghababaee A. Frequency of diencephalic syndrome in NMOSD. Acta Neurol Belg 2022; 122(4): 961-7.
- D'Amico D, La ML, Rigamonti A, Usai S, Mascoli N, Milanese C, et al. Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia 2004; 24(11): 980-4.
- Doi H, Matsushita T, Isobe N, Ishizu T, Ohyagi Y, Kira J. Frequency of chronic headaches in Japanese patients with multiple sclerosis: with special reference to opticospinal and common forms of multiple sclerosis. Headache 2009; 49(10): 1513-20.
- Masters-Israilov A, Robbins MS. Headache in neuromyelitis optica. Curr Pain Headache Rep 2017; 21(4): 20.
- Pittock SJ, Lennon VA, de SJ, Vermersch P, Homburger HA, Wingerchuk DM, et al. Neuromyelitis optica and non-organ-specific autoimmunity. Arch Neurol 2008; 65(1): 78-83.
- Rosciszewska-Zukowska I, Galiniak S, Bartosik-Psujek H. Clinical characteristics of headache in multiple sclerosis patients: A cross-sectional study. J Clin Med 2023; 12(10).
- Togha M, Rafiee P, Haghdoost F, Rafie S, Paknejad SMH, Amouian S, et al. The burdens attributable to primary headache disorders in children and adolescents in Iran: Estimates from a schools-based study. J Headache Pain 2024; 25(1): 86.
- Morreale M, Marchione P, Giacomini P, Pontecorvo S, Marianetti M, Vento C, et al. Neurological involvement in primary Sjogren syndrome: A focus on central nervous system. PLoS One 2014; 9(1): e84605.
- Wang Y, Zhang L, Zhang B, Dai Y, Kang Z, Lu C, et al. Comparative clinical characteristics of neuromyelitis optica spectrum disorders with and without medulla oblongata lesions. J Neurol 2014; 261(5): 954-62.
- Bradl M, Kanamori Y, Nakashima I, Misu T, Fujihara K, Lassmann H, et al. Pain in neuromyelitis optica--prevalence, pathogenesis and therapy. Nat Rev Neurol 2014; 10(9): 529-36.
- Ceylan M, Bayraktutan OF, Becel S, Atis O, Yalcin A, Kotan D. Serum levels of pentraxin-3 and other inflammatory biomarkers in migraine: Association with migraine characteristics. Cephalalgia 2016; 36(6): 518-25.
- Wang H, Wang K, Wang C, Zhong X, Qiu W, Hu X. Increased plasma levels of pentraxin 3 in patients with multiple sclerosis and neuromyelitis optica. Mult Scler 2013; 19(7): 926-31.
- Seok JM, Cho EB, Lee HL, Cho HJ, Min JH, Lee KH, et al. Clinical characteristics of disabling attacks at onset in patients with neuromyelitis optica spectrum disorder. J Neurol Sci 2016; 368: 209-13.
- Cavallini A, Micieli G, Bussone G, Rossi F, Nappi G. Headache and quality of life. Headache 1995; 35(1): 29-35.
- Choi SI, Lee YJ, Kim DW, Yang JY. A case of neuromyelitis optica misdiagnosed as cervicogenic headache. Korean J Pain 2014; 27(1): 77-80.
- Isago E, Ishizuchi K, Takizawa T, Fujiwara H, Izawa Y, Nakahara J. A case of neuromyelitis optica spectrum disorder in which headache preceded visual field disturbances by 2 months. Rinsho Shinkeigaku 2021; 61(11): 722-6. [In Japanese].
- Wang L, Su HJ, Song GJ. A rare case of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing with progression to neuromyelitis optica spectrum disorder. J Int Med Res 2020; 48(10): 300060520964349.
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