Kopfschmerzen und Multiple Sklerose

Zusammenfassung

Diese Übersicht berichtet über die Assoziation von Multipler Sklerose (MS) und Migräne, Spannungskopfschmerzen, Trigeminusneuralgie und den durch die immunmodulatorische Therapie verursachten Kopfschmerz. Die Migräneprävalenz in MS-Patienten liegt zwischen 20 und 45% und unterscheidet sich aufgrund von regionalen Besonderheiten, dem Geschlecht und der Art der immunmodulatorischen Therapie. In einigen Untersuchungen scheint insbesondere die Migräne mit Aura ein Risikofaktor für das Auftreten und ein Prädiktor für eine frühe Manifestation der MS zu sein. Spannungskopfschmerzen bestehen bei MS-Patienten nicht gehäuft. Kopfschmerzen sind bis zu fünfmal häufiger unter einer Therapie mit Beta-Interferonen als unter Glatirameracetat. Eine kurzzeitige Gabe von Koanalgetika bewirkt eine Verbesserung der Kopfschmerzen nach Beta-Interferon-Injektion. Eine Trigeminusneuralgie tritt bis zu dreimal häufiger bei MS-Patienten, in bis zu 18% aller betroffenen Patienten auch bilateral auf und ist häufig symptomatisch. Die Daten bezogen auf die Assoziation MS und Kopfschmerzen sind vielfach noch lückenhaft, sodass große populationsbasierte Studien mit Kontrolle der Konfounder sinnvoll erscheinen.

Summary

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 betainterferon 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.

Schlüsselwörter

Multiple Sklerose - Migräne - Spannungskopfschmerzen - Beta-Interferon

Keywords

Multiple sclerosis - migraine - tension type headache - beta interferon

• Literatur

• 1 Alstadhaug K, Breivik K, Rusic Z. Recurrent headache due to MS plaque. Headache 2008; 48: 453-454.
• 2 Arrese I. et al. Typical trigeminal neuralgia associated with brainstem white matter lesions on MRI in patients without criteria of multiple sclerosis. Acta Neurochir (Wien) 2008; 150: 1157-1161.
• 3 Boneschi FM. et al. Lifetime and actual prevalence of pain and headache in multiple sclerosis. Mult Scler 2008; 14: 514-521.
• 4 Breslau N. et al. Comorbidity of migraine and depression: investigating potential etiology and prognosis. Neurology 2003; 60: 1308-1312.
• 5 Cruccu G. et al. Trigeminal neuralgia and pain related to multiple sclerosis. Pain 2009; 143: 186-191.
• 6 D’Amico D. et al. Prevalence of primary headaches in people with multiple sclerosis. Cephalalgia 2004; 24: 980-984.
• 7 Davey R, Al-Din A. Secondary trigeminal autonomic cephalalgia associated with multiple sclerosis. Cephalalgia 2004; 24: 605-607.
• 8 DMKG Study Group. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol 2003; 250: 542-545.
• 9 Filippini G. et al. Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet 2003; 361: 545-552.
• 10 Gass A. et al. Trigeminal neuralgia in patients with multiple sclerosis: lesion localization with magnetic resonance imaging. Neurology 1997; 49: 1142-1144.
• 11 Gee JR, Chang J, Dublin AB, Vijayan N. The association of brainstem lesions with migraine-like headache: an imaging study of multiple sclerosis. Headache 2005; 45: 670-677.
• 12 Haas DC, Kent PF, Friedman DI. Headache caused by a single lesion of multiple sclerosis in the periaqueductal gray area. Headache 1993; 33: 452-455.
• 13 Kister I. et al. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 2010; 11: 417-425.
• 14 Kister I, Caminero AB, Herbert J, Lipton RB. Tension-type headache and migraine in multiple sclerosis. Curr Pain Headache Rep 2010; 14: 441-448.
• 15 Kister I, Munger K, Herbert J, Ascherio A. Increased risk of multiple sclerosis among women with migraine in the Nurses’ Health Study II. Poster presented at the American Academy of Neurology Annual Meeting, Toronto. 2010
• 16 La LMantia. Headache and multiple sclerosis: clinical and therapeutic correlations. Neurol Sci 2009; 30 (Suppl. 01) S23-S26.
• 17 Libera DD. et al. One-year prospective study on headache occurrence in multiple sclerosis (MS) patients treated with natalizumab. Poster presented at the American Academy of Neurology Annual Meeting; Toronto: 2010
• 18 Love S, Gradidge T, Coakham HB. Trigeminal neuralgia due to multiple sclerosis: ultrastructural findings in trigeminal rhizotomy specimens. Neuropathol Appl Neurobiol 2001; 27: 238-244.
• 19 Martínez HJSobrepera, Cabrera JAGómez, Tuero AIglesias. Exogenous factors in the aetiology of multiple sclerosis in Cuba. A study of cases and controls [in Spanish]. Rev Neurol 2001; 33: 931-937.
• 20 Nicoletti A. et al. Headache and multiple sclerosis: a population-based case–control study in Catania, Sicily. Cephalalgia 2008; 28: 1163-1169.
• 21 Nurmikko TJ, Gupta S, Maclver K. Multiple Sclerosis-related central pain disorders. Curr Pain Headache Rep 2010; 14: 189-195.
• 22 O’Connor AB. et al. Pain associated with multiple sclerosis: Systematic review and proposed classification. Pain 2008; 137: 96-111.
• 23 Paparrigopoulos T. et al. The neuropsychiatry of multiple sclerosis: focus on disorders of mood, affect and behavior. Int Rev Psychiatry 2010; 22: 14-21.
• 24 Pöllmann W. et al. Interferon beta but not glatiramer acetate therapy aggravates headaches in MS. Neurology 2002; 59: 636-639.
• 25 Pöllmann W, Erasmus LP, Feneberg W, Straube A. The effect of glatiramer acetate treatment on preexisting headaches in patients with MS. Neurology 2006; 66: 275-277.
• 26 Putzki N. et al. Prevalence of migraine, tension-type headache and trigeminal neuralgia in multiple sclerosis. Eur J Neurol 2009; 16: 262-267.
• 27 Putzki N, Katsarava Z. Headache in multiple sclerosis. Curr Pain Headache Rep 2010; 14: 316-320.
• 28 Scher AI, Stewart WF, Lipton RB. The comorbidity of headache with other pain syndromes. Headache 2006; 46: 1416-1423.
• 29 Schwartz BS, Stewart WK, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA 1998; 279: 381-383.
• 30 Vacca G. et al. Multiple sclerosis and headache comorbidity. A case-control study. Neurol Sci 2007; 28: 133-135.
• 31 Villani V. et al. Primary headache and multiple sclerosis: preliminary results of a prospective study. Neurol Sci 2008; 29 (Suppl. 01) S146-148.
• 32 Watkins SM, Espir M. Migraine and multiple sclerosis. J Neurol Neurosurg Psychiatry 1969; 32: 35-37.
• 33 Zorro O. et al. Gamma knife surgery for multiple sclerosis related trigeminal neuralgia. Neurology 2009; 73: 1149-1154.
• 34 Zorzon M. et al. Risk factors of multiple sclerosis: a case-control study. Neurol Sci 2003; 24: 242-247.
• 35 Compsten N, Mc DAlpine. Some aspects of the natural history of dissiminated sclerosis. Q J Med 1952; 21: 135-67.
• 36 Rolak LA, Brown S. Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol 1990; 237 (05) 300-2.