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MS & Migraines
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MS & Migraines

How does a doctor differentiate between migraines and MS?  I have been researching the connection and cannot find the criteria.  

I've been having an increase in migraine attacks and wonder if this is the cause or a symptom of new lesions.  I've had new lesions show up on my MRI in the periventricular and subcortical areas.  The radiologist writes that the differential is demyelinating disease or microvascular disease. BTW, I get the kind of migraine without aura.  In fact, I don't think I've ever had an aura.  The most significant of my disability is memory loss and cognitive dysfunction.  I am having more trouble with spasticity and numbness.

About three months ago is when the increase in migraines started back up.  I've been on Copaxone for three years.  I do not doubt I have MS because I've had optic neuritis twice for one, but I do wonder if the new lesions may be caused my migraines instead of MS activity.  My cholesterol is normal and blood pressure is under good control (even when I was having these migrain attacks).

Many people on this forum have been told that they have migraine attacks and not MS.  So, how do the doctors make that determination?  I have yet to find the criteria that doctors use to figure out if it's migraines causing the lesions or MS.

Here's what makes it confusing:
-50% or more of PWMS have migraines
-migraines can cause white matter lesions
-demyelinating lesions can look like microvascular lesions
- white matter lesions, from whatever the source, can cause MS-like symptoms (like in gait and balance)
- periventrical lesions can be formed by classic and common migraines

It could be a chicken versus the egg kind of thing.  Do lesions in certain areas by the veins (my guess is there lots of veins in the brain that can affected by inflammation from an MS attack).  Or are lesions helped onward by some kind of migraine/veinous event or inflammation?  


Here's what I found in my research:

Multiple Sclerosis as a Vascular Disease:
http://www.shreveportphysiology.com/Alexander-MS.pdf.pdf

Migraines are More Common in Women with Multiple Sclerosis:
http://www.sciencedaily.com/releases/2010/02/100216163324.htm

Migraines Can Cause Brain Lesions:
http://www.thisisms.com/article42.html

Women With Multiple Sclerosis Have a High Rate of Migraine (this article states that women with migraine have a 50% increase in developing multiple sclerosis):
http://www.medscape.com/viewarticle/717267

The Mutiple Sclerosis/Migraine Connection:
http://www.*************.com/multiple-sclerosis/c/67078/51863/connec

Demyelinating Diseases of the Brain (discusses causes of demyelination)
http://spinwarp.ucsd.edu/neuroweb/Text/br-840.htm

History of Severe Headache Linked to Increased Risk for White Matter Lesions in the Elderly:
http://www.medscape.com/viewarticle/720675

Migraines Linked to Brain Lesions:
http://www.webmd.com/migraines-headaches/news/20040127/migraine-linked-to-brain-lesions

Migraine "Hangover" (this article notes the relationship between migraines with auras and lesions--this is why I'm thinking possibly the headaches I'm getting may be caused from the lesion itself and not the migraine):
http://www.netplaces.com/migraines/recovery/migraine-hangover.htm

Here's another very good article, but it is very difficult to read.  I think this will unlock what I'm trying to find out, but I can't read it (I may as well be reading Greek):
http://radiology.rsna.org/content/231/3/645.long


There's not a wealth of information or studies done about this connection.

If you come across the criteria that neuros use to differentiate microvascular lesions from multiple sclerosis lesions, let me know!

Deb
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1753162_tn?1317281784
WOW I have a lot to read :) I have been having migraines/headaches daily for 5yrs which started not long after a car accident. (Bad case of whiplash, I assume this is the cause of them but who knows.) All this time I had been just trying to treat the constant headaches. It wasn't until the pins & needles, balance issues etc. started that made me think something may be connected here. I mean if my head hurts all the time and I'm forgetting things, falling over... well somehow to me it seems pretty connected? I just haven't a clue how.
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429700_tn?1308011423
LOL  I did put a lot up there for people to read!  I have been researching and researching about this topic.  I probably would have loved a job as a research scientist if I had the mind for it!

It's not uncommon for people with MS to have their first attack or an attack after a major accident. I've heard stories in this forum, off the Internet (YouTube), and Mystery Diagnosis from their first attacks starting after a major event).  

Hopefully, you find out sooner than Wednesday what exactly is going on with your MRI!  Oh well.  I guess it really is only a couple of days . . . Do you get migraines or is it a different kind of headache?  

I am so totally confused when it comes to this migraine and MS connection thing.  This neuro science medical stuff really boggles my mind!  When I was diagnosed, one of the things that my neuro said to me after I was telling him my adventures on the road to diagnosis was that it "wasn't rocket science".  I beg to differ . . .

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1753162_tn?1317281784
My hubby always says I read to much LOL But, I am the type of person that just has to know what's going on at all times, which I think is what is driving me the most crazy with all my symptoms... I don't know!

I have been having issues for almost 20yrs with always being tired and not feeling good. They have been checking me for Lupus and of course it's always neg. 20yrs later still neg. shesh let it alone already it's not Lupus lol They would put me on this med. or that med. to help and it did for a little (maybe in my head it did who knows?) but after the accident things got much worse. I know it was about 2 days after the accident I remember just laying on the sofa not wanting to get up I just felt terrible. My neck hurt so bad and just felt very blah and it's been down hill from there.

Yea, I have been waiting since forever to find out what is a few more days??? MY sanity lol When I did go to the neuro. after the accident he told me I was getting chronic daily headaches and migraines. My migraines aren't very often and usually only happen if I let the headache go which I tend to not do often. I get pain in my upper back/neck area. Mostly when I bend my head down to my chest but not electric shock pain. Almost feels as if I'm pulling my spine out when I bend my head lol I don't know how else to explain it. I did see a chiropractor as well, figured it can't hurt. He couldn't find anything that felt odd other then when he'd touch a certain area of my neck my one leg would get terrible pins and needles. Also, no medications for migraines or preventing migraines have helped. All I take is Excedrine for migraines, it's the only thing that keeps the pain calmed down.

I'm just so confused with everything :) I need to stop thinking about it but it's going to drive me nuts until I know what's going on. I wonder if the Drs even have a clue if it's connected. I'm starting to think they are playing a guessing game and I'm the guinea pig :)

Let me also add that while thinking about it, I have always gotten headaches just not often. It seems the worse my headaches get the worse I have gotten over the years.
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Avatar_f_tn
Hi Deb,
I have a similar problem to you, I have migraines and Transverse Myelitis.  My neurologist told me that my migraines are most likely due to my TM and that lesions in the brainstem and cervical are often associated with migraines.  I get lots of pins and needles and sometimes I think they are from my migraine and I found it difficult to differentiate between the two, when I asked him he said that tingling from a migraine is most likely either in your hands or your feet, more likely to come and go, or face tingling but it is very hard to tell the difference.

I think too that with migraine lesions they are very often in different spots to what is typical for a MS lesion and often their shape is different too, but I might be wrong about this.  I might also say that their are people on this forum who were diagnosed initially with migraine lesions and then when more lesions appeared on subsequent MRI their diagnosis was changed, so there must be a fine line.  I am by no means an expert, but I get migraines and have a neurological problem similar to MS.

Hope this helps, Udkas.
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