Headache Medicine, v.10, n.1, p.2-4, 2019

ABSTRACT

RESUMO

Descritores: Enxaqueca; Migrânea; Cefaleia; Esclerose Múltipla; Interferona

ORIGINAL ARTICLE

ID-Migraine is a sensitive tool for screening migraine

among patients with multiple sclerosis

ID-Migraine é uma ferramenta sensível para identicação de

enxaqueca em pacientes com esclerose múltipla

Marcos Vinícius de Queiroz

Washington Luiz G. Medeiros Jr

Audred C. Biondo Eboni

Eduardo A. Guimaraes Nogueira

Marcus Vinicius M. Gonçalves

Nise Alessandra C. Sousa

Yara Dadalti Fragoso

Department of Neurology and Programa

de Pós-Graduação em Saúde e Ambiente,

Universidade Metropolitana de Santos, Santos,

SP, Brazil

Department of Neurology, Universidade da

Região de Joinville, Joinville, SC, Brazil

Department of Neurology, University Hospital

Getulio Vargas, Manaus, AM, Brazil

*Correspondence

Yara Dadalti Fragoso

E-mail: yara@bsnet.com.br

Received: November 24, 2018.

Accepted: January 13, 2019.

Introduction: Migraine and multiple sclerosis (MS) have been described as

comorbidities. While other types of headaches can be seen in patients with

MS, it is migraine that usually adds to the burden of patients suffering from an

already disabling and chronic neurological disease. Migraine is more prevalent

in patients with MS than in the general population, and can be worsened by

certain treatments that are used to control MS. ID-migraine is a tool to screen

migraine in a population. It consists of only three self-reported questions, and

shows good sensitivity, specicity and reliability. The aim of the present study

was to assess the role of ID-migraine as a potential tool for screening migraine

in patients with MS. Method: Patients diagnosed with MS for at least one

year were invited to answer ID-migraine. Demographic data and information

on MS therapy were obtained at the same time. Results: Sixty-two patients

participated in the study. There were 16 men and 46 women, of average age

35 years. Migraine was identied in 51.5% of them and 18% reported having

the characteristics of chronic migraine. ID-migraine showed 93% sensitivity

and specicity for migraine in this population. The medication most frequently

associated with worsening of previous migraine was interferon beta 1-a (27.4%

of the cases). Conclusion: ID-migraine was shown to be a potential tool for

identifying migraine in patients with MS. However, the high prevalence of

migraine in this population may have constituted a selection bias, since most

patients without headache may not have felt inclined to participate in this

voluntary investigation. The results from this pilot study will be expanded and

investigated in more detail in a large national study.

Keywords: Migraine; Headache; Multiple Sclerosis; Interferon.

Introdução: Enxaqueca e esclerose múltipla (EM) têm sido descritas como

comorbidades. Enquanto outros tipos de cefaleia podem ser vistos em pacientes

com EM, é a enxaqueca que geralmente completa a incapacidade de um paciente

que já sofre de uma doença neurológica crônica e incapacitante. Enxaqueca é

mais prevalente em pacientes com EM do que na população geral e pode piorar

quando certos tratamentos são utilizados para o controle da EM. ID-Migraine

é uma ferramenta utilizada para avaliar enxaqueca em populações. Consiste em

apenas três questões auto relatadas, mostrando boa sensibilidade, especicidade

e conabilidade. O propósito do presente estudo foi avaliar o papel de ID-Migraine

como potencial ferramenta para determinação de casos de enxaqueca em

pacientes com EM. Método: Pacientes diagnosticados com EM por pelo menos um

ano foram convidados a responder ID-Migraine. Dados demográcos e informações

sobre tratamento da EM foram obtidos na mesma ocasião. Resultados: Sessenta

e dois pacientes participaram deste estudo. Foram 16 homens e 46 mulheres, com

média de idade de 35 anos. Enxaqueca foi identicada em 51,5% deles, sendo que

18% relataram características de enxaqueca crônica. ID-Migraine mostrou 93%

sensibilidade e especicidade para esta população enxaquecosa. A medicação

mais frequentemente associada com piora de enxaqueca previamente existente

foi a interferona beta 1-a (27,4% dos casos). Conclusão: ID-Migraine mostrou-se

uma opção para identicação de casos de enxaqueca em pacientes com EM. No

entanto, a alta prevalência de enxaqueca na população estudada pode reetir um

viés de seleção, uma vez que muitos pacientes sem cefaleia podem não ter se

sentido dispostos a participar da investigação. Os resultados deste estudo piloto

serão expandidos e investigados com maiores detalhes em um amplo estudo

nacional.

10(1).indb 2 21/10/2019 19:33:56

Migraine and MS

Queiroz MV, et al.

Headache Medicine, v.10, n.1, p.2-4, 2019

INTRODUCTION

Patients with multiple sclerosis (MS) are consistently

reported as having higher prevalence of headaches,

particularly migraine

. The reason for this nding is yet

to be claried, but the predominance of inammatory

cytokines and adverse events from medications

rate highly among the potential causes of increased

prevalence of headache among MS cases

. In addition,

demyelinating lesions in and around the periaqueductal

grey area may be associated to (often-intractable)

headaches in patients with MS

3,4

. Adverse events

relating to MS therapy may also account for the onset or

worsening of migraine

5,6

ID-Migraine is a simple three-item questionnaire

that is used for screening migraine cases in primary care.

However, it has only rarely been used in MS clinics

. It has

been validated in several languages, including Brazilian

Portuguese

. Only one previous study investigated the

potential use of ID-Migraine among patients with MS

In this previous Italian study, ID-Migraine showed high

sensitivity (91%) and specicity (94%) for identifying

migraine in 144 patients with MS. The present investigation

was a pilot study with the aim of expanding these data,

through including a population of Brazilian patients with

MS in which ID-migraine was used.

METHOD

This was a cross-sectional study carried out in three

university MS centers. Patients with MS attending regular

consultations at these centers were invited to reply to an

online questionnaire that sought ID-migraine responses.

Cases of episodic and chronic migraine were diagnosed

in accordance with thecriteria of the International

Headache Society (ICDH-3)

.Details of these patients’

MS therapy were recorded. All information was obtained

online without identication of patients.No healthcare

professional had any inuence on the responses that

patients gave. Only patients with at least one year of

conrmed diagnoses of MS were included in the study.

The results are presented mainly in a descriptive manner.

RESULTS

Sixty-two patients entered this pilot study. The

group consisted of 16 men and 46 women, of average

age 35 years. All of them had had a diagnosis of MS for

at least one year. Migraine was identied in 51.5% of these

patients. Among these individuals, 69% reported having

aura occasionally, but most attacks were migraine without

aura. Eighteen percent of the patients with migraine

fullled the diagnostic criteria of chronic migraine.

ID-Migraine identied 10 men and 20 women as

migraineurs in this study. Using the ICDH-3 criteria,

eight men and 20 women had all the necessary items

for diagnosing migraine.Thus, ID-Migraine presented 93%

specicity. The questionnaire showed 100% sensitivity,

since no cases of migraine were identied using the

ICDH-3 criteria and not through ID-Migraine.

Thirty-one patients in this study reported having had

migraine episodes before they received the diagnosis

of MS, while only one person started having migraine

after being diagnosed with MS. Onset or worsening

of migraine due to MS therapy was observed in 20

patients (62.5%). Interferon beta 1-a led to worsening of

migraine in 27.4% of the patients, irrespectively of the

mode of administration of this drug (subcutaneously or

intramuscularly).

DISCUSSION

This pilot study showed that ID-Migraine is a sensitive

and specic tool for screening migraine in populations of

patients with MS. If we apply this questionnaire in our

MS centers, we may be able to identify a large group of

patients in need of special attention to their headache.

MS clinics tend to concentrate efforts on maintaining

good neurological function, appropriate mobility,

visual ability, adequate coordination and sphincter

function, cognition, control of neuropathic pain (such as

trigeminal neuralgia), but without any specic programs

for attending to primary headaches. Since migraine can

negatively inuence patients’ quality of life, mood, sleep

and cognition

, it is important to address migraine in

patients with MS.

The very high prevalence of migraine in this

population (51.5%) may have been biased by the online

tool that was used for screening. It is plausible that only

individuals who suffer from headache might feel inclined

to reply to an online survey on headache. However, other

studies have reported migraine in 50% of patients with

2,4

and the results obtained here may just reect

the same prevalence in Brazilian patients. In fact, the

only other previous study using ID-Migraine to screen

patients with MS showed that 53.5% of the patients had

a diagnosis of migraine.

Interferon beta 1-a was associated with worsening

of migraine in these patients. This nding has been

systematically reported by other authors

5,6,12

and often

directs neurologists caring for patients with MS not

to prescribe interferon beta 1-a whenever there is a

concomitant history of migraine. More recently, other

drugs have been described as headache triggers

, but

the population of this pilot study did not allow for further

assessments.

CONCLUSION

ID-migraine was a sensitive tool for identifying

migraine in patients with MS and its use can be

implemented in MS units. As previously described by

several groups, interferon beta may worsen migraine

symptoms.

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