Women With Multiple Sclerosis Show Increased Migraine Risk Before Symptom Onset

Women with multiple sclerosis (MS) show increased risk for migraine for up to a decade prior to MS symptom onset, according to study results published in The Journal of Headache and Pain.

Researchers conducted a prospective, population-based cohort study to evaluate the occurrence of migraine and other headache types in women who later developed MS. Pregnant women from Norway were enrolled, and data for the analysis were captured from 1999 to 2008. Patients were administered questionnaires between pregnancy week 17 and 20 that captured information on migraine history as well as demographic and clinical characteristics. The researchers compared migraine risk between women who developed MS during the study period and women without MS (reference group). Logistic regression was used for statistical analysis.

Among patients who completed the questionnaire, 246 developed MS over a median follow-up period of 13 (IQR, 11-15) years and 85,292 were in the reference group. The median time to MS symptom onset and diagnosis was 6 (IQR, 3-9) and 8 (IQR, 5-10) years, respectively. Most (97%) patients in the MS group had relapsing-onset disease.

Compared with the reference group, women who developed MS were younger, more likely to report overweight status prior to pregnancy, and more likely to report a history of smoking.

The number of patients who reported any previous migraine occurrence was higher among those who developed MS compared with those in the reference group (18% and 11%, respectively; crude odds ratio; 1.7; 95% CI, 1.2-2.3). Moreover, the association between migraine risk and MS onset was observed after adjustment for age, smoking history, socioeconomic status, and overweight status (adjusted odds ratio [aOR], 1.6; 95% CI, 1.2-2.3). Additional adjustment for previous or current depression and anxiety symptoms produced similar findings (aOR, 1.5; 95% CI, 1.1-2.2).

Further analysis of women who developed MS showed increased migraine risk in those who reported disease onset within 5 years (aOR, 1.7; 95% CI, 1.1-2.8; P =.029) or within 6 to 10 years (aOR, 1.9; 95% CI, 1.1-3.2; P =.016). However, the researchers observed no increased risk for migraine in patients who developed MS after 10 years. Overall, migraine risk increased by 12% per year closer to MS symptom onset (aOR 1.12; 95% CI, 1.0-1.3).

Study limitations include the potential misclassification bias, the lack of nuanced information on headache symptoms, and the small of women who developed MS after 10 years.

The researchers concluded, “The increased occurrence of migraine among women in the prodromal phase of MS shown in this study, implies that clinicians should give special attention to people with migraine with symptoms or heightened risk of MS, to ensure timely recognition and treatment.”

Disclosure: Some study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Clinical Pain Advisor