Multiple sclerosis presenting initially with a worsening of migraine symptoms

Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6–28.5%; however, it remains unclear whether headache is a true symptom of MS onset....

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Main Authors:	Lin, Guan-Yu, Wang, Chih-Wei, Chiang, Tsung-Ta, Peng, Giia-Sheun, Yang, Fu-Chi
Format:	Online
Language:	English
Published:	Springer 2013
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751257/

id	pubmed-3751257
recordtype	oai_dc
spelling	pubmed-37512572013-08-27 Multiple sclerosis presenting initially with a worsening of migraine symptoms Lin, Guan-Yu Wang, Chih-Wei Chiang, Tsung-Ta Peng, Giia-Sheun Yang, Fu-Chi Case Report Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6–28.5%; however, it remains unclear whether headache is a true symptom of MS onset. Here, we report the case of a female patient who had a history of migraine without aura and experienced worsening of migraine-headache symptoms as the initial manifestation of MS. Three similar cases were reported previously; however, unlike this case, those cases had no history of migraine without aura. In our case, we excluded factors that could trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger. The patient had one episode of MS attack with the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions, including hyperintense lesions in the bilateral periventricular white matter, body of the corpus callosum, and periaqueductal grey matter, as observed on the T2-weighted images obtained at the first brain magnetic resonance imaging. In addition, after the injection of gadolinium contrast, ring enhancement over these lesions was noted in T1-weighted images, which was suggestive of active demyelination. MS was diagnosed according to the McDonald criteria (2010 revision). We conclude that MS with periaqueductal grey matter involvement may present with worsening migraine. It is important to be cautious if any secondary causes exist, especially when the patient has a history of migraine without aura. MS should be one of the differential diagnoses in young women showing a change in headache pattern or poor clinical drug response to migraine treatment accompanied by episodes of focal neurological deficit. Failure to recognize MS may lead to inappropriate treatment and worse prognosis; early diagnosis in patients with MS is essential to improve their clinical outcomes and quality of life. Springer 2013 2013-08-09 /pmc/articles/PMC3751257/ /pubmed/23937696 http://dx.doi.org/10.1186/1129-2377-14-70 Text en Copyright ©2013 Lin et al.; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Lin, Guan-Yu Wang, Chih-Wei Chiang, Tsung-Ta Peng, Giia-Sheun Yang, Fu-Chi
spellingShingle	Lin, Guan-Yu Wang, Chih-Wei Chiang, Tsung-Ta Peng, Giia-Sheun Yang, Fu-Chi Multiple sclerosis presenting initially with a worsening of migraine symptoms
author_facet	Lin, Guan-Yu Wang, Chih-Wei Chiang, Tsung-Ta Peng, Giia-Sheun Yang, Fu-Chi
author_sort	Lin, Guan-Yu
title	Multiple sclerosis presenting initially with a worsening of migraine symptoms
title_short	Multiple sclerosis presenting initially with a worsening of migraine symptoms
title_full	Multiple sclerosis presenting initially with a worsening of migraine symptoms
title_fullStr	Multiple sclerosis presenting initially with a worsening of migraine symptoms
title_full_unstemmed	Multiple sclerosis presenting initially with a worsening of migraine symptoms
title_sort	multiple sclerosis presenting initially with a worsening of migraine symptoms
description	Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6–28.5%; however, it remains unclear whether headache is a true symptom of MS onset. Here, we report the case of a female patient who had a history of migraine without aura and experienced worsening of migraine-headache symptoms as the initial manifestation of MS. Three similar cases were reported previously; however, unlike this case, those cases had no history of migraine without aura. In our case, we excluded factors that could trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger. The patient had one episode of MS attack with the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions, including hyperintense lesions in the bilateral periventricular white matter, body of the corpus callosum, and periaqueductal grey matter, as observed on the T2-weighted images obtained at the first brain magnetic resonance imaging. In addition, after the injection of gadolinium contrast, ring enhancement over these lesions was noted in T1-weighted images, which was suggestive of active demyelination. MS was diagnosed according to the McDonald criteria (2010 revision). We conclude that MS with periaqueductal grey matter involvement may present with worsening migraine. It is important to be cautious if any secondary causes exist, especially when the patient has a history of migraine without aura. MS should be one of the differential diagnoses in young women showing a change in headache pattern or poor clinical drug response to migraine treatment accompanied by episodes of focal neurological deficit. Failure to recognize MS may lead to inappropriate treatment and worse prognosis; early diagnosis in patients with MS is essential to improve their clinical outcomes and quality of life.
publisher	Springer
publishDate	2013
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751257/
_version_	1612005445428314112

Multiple sclerosis presenting initially with a worsening of migraine symptoms

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