Study links headaches in NMOSD to changes in the brain
MRI abnormalities, rituximab tied to more chance of new, worsening headaches
Nearly all adults with neuromyelitis optica spectrum disorder (NMOSD) experience headaches, especially migraines, a single-center study in Iran suggests.
The presence of abnormalities in brain MRI scans and the use of the immunosuppressive therapy rituximab were each linked to an increased chance of new or worsening headaches after a NMOSD diagnosis, according to data.
“Improved recognition and management of headaches in NMOSD are crucial for optimizing patient outcomes and quality of life,” the researchers wrote. The study, “Assessment of different types of headaches, their prevalence, and contributing factors on Neuromyelitis Optica Spectrum Disorder patients,” was published in Multiple Sclerosis and Related Disorders.
NMOSD is a chronic inflammatory disorder that mainly affects the spinal cord and the optic nerve, which relays signals between the eyes and the brain. Spinal cord inflammation manifests as burning or tingling pain, or painful muscle contractions, while optic nerve inflammation can lead to various visual problems. Most patients will have flare-ups, or relapses, followed by periods of recovery, with disability often worsening with each relapse.
“Emerging evidence highlights the under-recognized burden of brain-related symptoms, including chronic pain and headaches,” the researchers wrote. “Headaches, especially migraines, are prevalent in NMOSD patients, and have a profound impact on their [quality of life] and occupational functioning.”
Abnormal MRI findings, rituximab use tied to headaches in NMOSD
Still, the frequency, clinical features, and contributing factors of headaches in people with NMOSD “remain poorly understood,” wrote the researchers, who analyzed demographic and clinical data, along with responses to a questionnaire, from 84 adults at an Iranian hospital. Most were women (81%) and their mean age was 39.33.
Nearly all (91.6%) reported headaches in the past six months, with most of them lasting between three and 72 hours (62.3%), at a frequency of two to 15 days per month (71.4%).
The most common type of headache was migraine (63.6%), followed by tension-type headaches (36.4%). Headaches were most frequently located in the front of the head (74%) and on the side (72.7%), and most (84.4%) were relieved with oral painkillers within an hour.
The onset of headaches occurred more often three months before the first NMOSD attack (70.1%), while a few patients reported it at the same time or within three months after an attack (14.3%).
In MRI scans, most participants (77.4%) had abnormal findings, which were significantly more common in those with headaches than those without (80.5% vs. 42.8%). Spinal cord involvement was frequent (61.9%), followed by brain involvement (33.3%) and optic nerve involvement (22.6%).
Those who developed new or worsened headaches after being diagnosed were slightly younger than those without changes in headache patterns after their diagnosis (37.16 vs. 40.60 years). Those with new or worsened headaches were also significantly more likely to show abnormal MRI findings. No differences were noted between the groups regarding age at the time of diagnosis, time from diagnosis, sex, level of education, and blood results, however.
Having abnormal MRI findings was significantly associated with a nearly seven times higher likelihood of a new or worsened headache after a NMOSD diagnosis, statistical analyses to identify potential contributors of headaches showed.
“Previous research indicated that a considerable percentage of NMOSD patients present with brain MRI abnormalities” and these changes “are often associated with a range of neurological symptoms, including headaches,” the researchers wrote.
Using rituximab, which is sold as Rituxan, among others, was also significantly linked to a nearly threefold higher likelihood of a new or worsened headaches after a diagnosis.
While “headache is a recognized side effect of rituximab, a cornerstone treatment for NMOSD,” potential effects of other treatments “should also be considered when evaluating headache in NMOSD patients,” the researchers wrote.
“This study highlights the significant burden of primary headaches in NMOSD patients, emphasizing the role of structural [brain and spinal cord] changes and treatment regimens as potential contributing factors,” they wrote. “Future research should focus on exploring the underlying mechanisms of headache … in NMOSD and developing targeted therapeutic strategies to address this debilitating symptom.”
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