Migraine in multiple sclerosis patients: potential links and treatment approach

ABSTRACTIntroduction Migraine has been reported to be twice as prevalent in patients with multiple sclerosis (MS) compared to the non-MS population. However, prospective, controlled studies that could lead to robust conclusions are still lacking.Areas covered Treatment of migraine in patients with MS can be challenging. Comorbidities need to be assessed and managed early, and preventive treatment should be initiated when indicated. Caution is warranted regarding the selection of the preventive medication since certain agents can magnify MS symptoms and particularly cognitive symptoms. This paper aims to discuss the association of MS and migraine, shed light on distinguishing points and red flags, as well as offer practical advice on the selection of treatment according to patients’ characteristics.Expert opinion A holistic approach including pharmacological and non-pharmacological modifications is required to treat migraine in patients with MS effectively. Anti-CGRP monoclonal antibodies are a promising option due to limited drug-to-drug interactions; however, larger prospective studies are required to draw robust conclusions on the concomitant use of anti-CGRPs with MS disease modifying treatments. Early migraine preventive treatment might be needed to reduce the burden of disease in patients with MS.KEYWORDS: Multiple sclerosisheadachemigrainetreatmentexpert opinion Article highlights Treating migraine in patients with MS can be particularly challengingThe link between MS and migraine has not been established yetComorbidities should be addressed early to improve outcomesAnti-CGRPs represent a very promising class of preventive medication with excellent safety profile and high efficacy but more data in MS are requiredDeclaration of interestD. D. Mitsikostas has received honoraria, research, and travel grants from Allergan/AbbVie, Amgen, Biogen, Cefaly, Genesis Pharma, Eli Lilly, Electrocore, Lundbeck, Mertz, Merck-Serono, Novartis, Roche, Sanofi, Specifar, and Teva. He participated in clinical trials for Amgen, Novartis, Cefaly, Eli Lilly, Electrocore, Genesis Pharma, Lundbeck, Mertz, Specifar, and Teva as principal investigator. He is a president of the board of the Hellenic Headache Society and a co-chairman of the management group of the Headache Section at the European Academy of Neurology. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.