Migraine Headaches And Pain With Neuropathic Characteristics: Comorbid Conditions In Patients With Multiple Sclerosis.

ArticleinPain 154(12) · August 2013with39 Reads
DOI: 10.1016/j.pain.2013.07.050 · Source: PubMed
  • 24.44 · Centre Hospitalier Universitaire de Clermont-Ferrand, Inserm U987, Inserm U1107 - NeuroDol
  • 36.14 · University of Auvergne
  • 27.58 · Centre Hospitalier Universitaire de Clermont-Ferrand
  • 41.17 · Centre Hospitalier Universitaire de Clermont-Ferrand
We conducted a postal survey to assess the prevalence and characteristics of neuropathic pain and migraine in a cohort of multiple sclerosis (MS) patients. Of the 1300 sent questionnaires, 673 could be used for statistical analysis. Among respondents, the overall pain prevalence in the previous month was 79%, with 51% suffering pain with neuropathic characteristics (NC) and 46% migraine. MS patients with both migraine and NC pain (32% of the respondents) reported more severe pain and had lower health-related quality of life than MS patients with either migraine or NC pain. Pain intensity in MS patients with migraine was moderate (6.0±0.1). Migraine was mostly episodic but headaches were occurring on 15 or more days per month in 15% of these migraine sufferers. MS patients with migraine were younger and had shorter disease durations than those with NC pain. NC pain was most often located in the extremities, back and head, and was frequently described as tingling and pins-and-needles. The intensity of NC pain was low to moderate (4.9±0.1), but positively correlated with the number of painful body sites. Nonetheless, patients with NC pain were more disabled (with a higher EDSS and pain interference index) than migraineurs. Migraine, but not NC pain, was associated with age, disease duration, relapsing-remitting course and beta interferon treatment. This suggests that NC pain and migraine are mediated by different mechanisms. Therefore, pain mechanisms that specifically operate in MS patients need to be characterized to design optimal treatments for these individuals.

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    • "In a survey of 673 individuals, migraine was more common in participants with neuropathic pain and vice versa (Moisset et al., 2013 ). Comorbid migraine and neuropathic pain were also associated with more intense headache pain, more intense neuropathic pain, and greater disruption of normal activities (Moisset et al., 2013). We found that depression was associated with 1.58-fold increased odds of pain. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Comorbidities are common in multiple sclerosis (MS). The high prevalence of pain in MS is well-established but the influence of comorbidities on pain, specifically, pain-related interference in activity is not. Objective: To examine the relationship between comorbidity and pain in MS. Methods: We recruited 949 consecutive patients with definite MS from four Canadian centres. Participants completed the Health Utilities Index (HUI-Mark III) and a validated comorbidity questionnaire at 3 visits over 2 years. The HUI's pain scale was dichotomized into two groups: those with/without pain that disrupts normal activities. We used logistic regression to assess the association of pain with each comorbidity individually at baseline and over time. Results: The incidence of disruptive pain over two years was 31.1 per 100 persons. Fibromyalgia, rheumatoid arthritis, irritable bowel syndrome, migraine, chronic lung disease, depression, anxiety, hypertension, and hypercholesterolemia were associated with disruptive pain (p<0.006). Individual-level effects on the presence of worsening pain were seen for chronic obstructive pulmonary disease (odds ratio [OR]: 1.50 95% CI: 1.08-2.09), anxiety (OR: 1.49 95% CI: 1.07-2.08), and autoimmune thyroid disease (OR: 1.40 95% CI: 1.00-1.97). Conclusion: Comorbidity is associated with pain in persons with MS. Closer examination of these associations may provide guidance for better management of this disabling symptom in MS.
    Full-text · Article · Sep 2015
    • "In addition, neuropathic pain is frequent in patients with MS and can be concomitantly present with migraine (Moisset et al., 2013). In a recent study, 32% of the MS patients who presented both with migraine and neuropathic pain, had more severe pain and lower health-related quality of life than MS patients with either migraine or neuropathic pain alone (Moisset et al., 2013). The pain intensity in MS patients with migraine was higher (6.0 ± 0.1) than that of neuropathic pain (4.9 ± 0.1). "
    [Show abstract] [Hide abstract] ABSTRACT: Background and objectives While the literature supports the idea that multiple sclerosis (MS) and migraine are related, the exact mechanism(s) of this association is not well understood. Observations of increased contrast enhancing (CE) lesion activity in individual MS patients suffering from migraine prompted us to determine a relationship between migraine and MRI outcomes in a large cohort of MS patients. Methods We included 509 MS and 64 clinically isolated syndrome (CIS) patients and 251 age- and sex-matched healthy individuals (HIs) who obtained 3 T MRI and were assessed for history of migraine. Number and volume of T2, T1 and CE lesions and brain volume measures were determined. The MRI findings were analyzed adjusting for key covariates and correcting for multiple comparisons. Results More MS (22.2%) and CIS (17.2%) patients had migraine, compared to HIs (14.6%, p = 0.067). More MS patients with migraine presented with CE lesions compared to those without (35.4% vs. 23.7%, p = 0.013). MS migraine patients had significantly increased number (p = 0.019) and volume (p = 0.022) of CE lesions compared to those without. In the regression analysis, MS migraine patients had an increased number of CE lesions (B = 1.242, p = 0.001), specifically those with relapsing–remitting disease course (B = 1.377, p = 0.001). No significant association of other MRI measures and migraine was found in MS and CIS patients or in HIs. Conclusions Our findings suggest an increased inflammatory pathobiology in MS patients with migraine headaches requiring possibly more frequent MRIs and also more efficient anti-inflammatory treatment.
    Full-text · Article · Aug 2015
  • Article · Aug 2013
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