الفهرس 
Migraine headacheOnly 14 pages are availabe for public view
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Abstract
SUMMERY AND CONCLUSION
Multiple sclerosis is an immune-mediated chronic disorder
of the central nervous system in young adults, characterized by a
spatial and temporal dissemination of the pathological process, with
multiple areas of inflammation, demyelination, and glial sclerosis
are observed in the white matter. Various symptoms and signs
occur due to the affected areas in the brain and the spinal cord.
Migraine is a complex, common, and disabling disorder of
the brain, which is characterised by recurrent attacks of
pulsationg moderate to severe headache associated with sensory
symptoms pain and sensitivity to normal afferent information,
such as light, sound, and head movement , in which both central
and peripheral components of
The trigeminal pain pathway probably plays a significant
role, both in the symptoms and signs of the attack and in the
mechanisms of action of antimigraine compounds.
Migraine headache is a common feature in MS patients with
variable prevalence among the studies 1.6–28.5% up to 60%. It
can influence the diagnosis, radiological evaluation, treatment,
and quality of life of these patients. Similarities in symptoms
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between patients with migraine and MS presenting with headache
can lead to misdiagnosis. Likewise, MRI lesions which may be
found in migraine patients without other neurological symptoms
or signs may cause diagnostic confusion and patient anxiety.
Studies addressing the pathophysiology of these comorbid
conditions have not found a clear link, but brain stem lesions
during the inflammatory processes, changes in the cytokines
during the relapse , alternation in BBB permeability during
migraine attacks and disease-modifying agents mode of action and
side effect profiles have been proposed as possible association
factors . Thorough evaluation of headache especially migraine
headache in patients with MS is crucial to optimize patient
management to help improve quality of life. Management of de
novo or treatment-induced headache in the MS patient is fairly
straightforward if the physician is aware of the problem.
In our study 55 MS patients diagnosed according to revised
Mc Donald criteria recruited from Neurology Departments, Ain
Shams University Hospitals from which patients were subjected to
thorough medical history taking, stressing on age at onset of MS,
duration of illness, current therapy, yearly exacerbation rate and
age of onset of migraine headache. Migraine diagnosis was done
using a questionnaire based on criteria proposed by the
International Classification of Headache Disorders 2nd Edition
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(ICHD2) , neurological disability evaluation was done by means
EDSS and Migraine severity evaluation was done using MIDAS
, MS severity was assessed MSS .
In our 55 MS patient’s sample, 44 were female patients
representing 80% & 11 were male patients representing 20% of
the sample with Mean age 31.1 ± 7.9 years.
Migraine headache was present in 19 patients (34.5%),
which is a higher percentage than the general population.
The mean age of onset of migraine headache among our
studied group 22.27 ± 6.4 years, and the mean age of MS onset in
this group 25± 7.04 which indicates that the majority of patients
with coexisting Migraine and MS develop migraine years earlier.
There was no statistical significant difference between the
two patient groups regarding age of onset of MS, duration of
illness and annual relapse rate EDSS or MSSS.
However midbrain periaquidactal affection in MRI being
more prevalent among MS patients with migraine. Also There
was statistical significant correlation between occurence of severe
migraine attack before MS relapse in patients who developed
migraine headache for the first time conccurently with 1st MS
presentation.
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Initiation of DMT and increase in the migraine severity
which could be explained due to change in the cytokines balance.
In conclusion Migraine is comorbid in patients with MS.
The exact etiology and pathogenesis of these two seemingly
disparate disorders is not completely understood.
Research as to how and why they co- occur leads to
improvement in the understanding of each. This research has
contributed to the recognition of migraine symptoms and
headache in MS, improving our diagnostic skills and care of these
patients. In addition, it has strengthened our knowledge of the role
of pain-modulating structures of the brainstem, and
neuroimmunologic and inflammatory mechanisms which
contribute to migraine. Such collaboration may one day culminate
in the prevention and cure of two currently incurable and
debilitating diseases