funny. i was just reading up on this LAST NIGHT!! Apparently when lesions are active, there is a bit of edema surrounding the lesion it self. Accompanied with cranial swelling and pressure, absolutely lesions can cause head aches. I have had a terrible head ache for a week or two now. Last Friday, just by prior scheduled appt, an MRI was done and sure enough there is another new lesion. Right where my head has been aching..
I'm thinking that the paper on differential diagnosis puts headaches as a major flag - meaning it isn't MS related in the opinions of the international panel of experts who worked on this study. Which also means that headache would not be considered a symptom of known MS.
It sure seems the experiences around here are different.
You can read the paper at
Headaches (Cephalgias) are one of the more difficult medical problems to diagnose and treat. So the following is a bit of a book:
Cephalgia (the fancy medical name for a headache) is a strange set of disorders. Since the brain tissue lacks pain receptors, inflammation of the brain needs to be pretty diffuse (big changes in pressure or mass effect) to cause pain. This is the main reason doctors will not buy into the idea that a lesion will cause a headache. Localized lesion inflammation is on too small a scale to cause the shifts in volume or mass effect required to generate the pain. It would need to involve pressure on cranial nerves, eyes or other structures to generate a pain signal. Migraines and other vascular headaches are more about the vasospasm than the inflammation (this is why cafergot can break a migraine and narcotics may not.)
Inflammation of external structures in the neck, jaw, sternoclidomastoid muscles, etc. is a tyipcal cause of tension headaches.
Being able to "point" to a headache is a pretty good indication that it is a muscular skeletal or a tension headache. In that case it is something external to the brain. Increased Intracranial Pressure (ICP) or tumor with mass effect typically cause generalized pain and lethargy. A patient is say it hurts, but will not be able to localize the pain.
In MS, there seems to be a relationship between headaches and infratentorial lesions. Lesions on the cranial nerves effect eye movement, trigeminal neuralgia and facial pain syndrome, etc. Headache is associated with most of these processes. Spinal lesions cal also effect some of the cranial nerves. Eye stress, vertigo/balance issues and general stress can also lead to headaches.
So there are headaches in MS, but they are usually "secondary symptoms." MS caused TN and the TN gives me headaches, but the lesion on CN5 doesn't cause the headache directly.
MS caused my Optic Neuritis and the ON cause double vision that causes headaches, but the headaches are symptom of the eye strain. MS did not cause the headaches.
I have heard a lot about headaches and I have more of them since the MS, but linking the headache to MS as the cause is the problem. When you talk to a neurologist, you might have better luck saying: "The MS is causing my nystagmus and the nystagmus must be causing eye strain because after a few hours in front of the computer I get a headache."
OK. The pain from a migraine is based in the vasospasm. Lesions can cause spasms. But lesions do not cause the pain of the migraine. It is a secondary symptom.
The point of my diatribe above is that when Neuros look at MS, lesions form where there are no pain receptors, so lesions can't be painful. The things that lesions do: Spasms, false sensory signals, etc. can all cause pain. So Lesion -> Spasm -> Pain means pain is a secondary symptom. The original post was that "VA will not recognize headaches/migraines as a secondary issue." The argument should be: "Will the recognize that lesions can cause vascular spasms like other spasticity in the body?" If YES, then they need to recognize that those vasospasms are cause vascular headaches and pain.
The other issue is that the referenced article does nothing to help a male suffering with migraines since the study cohort was only females. "The American Academy of Neurology (AAN) announced research results on February 16th, determining that migraines may be more prevalent among women with multiple sclerosis (MS) than among the general female population."
These are VA contract docs. You have to walk them through the logic. They don't get paid enough to think that far ahead. Most VA Neuro departments are a little overworked now days. They have way to many closed head injuries and phantom limb pain patients. While this doesn't excuse poor care for MS patients, you may need to lead them through the steps.
He can try, but one of the problems with studies is they only apply to what is studied. That study showed that there was a statistically, "Migraines are more common in women who have MS." There is no link of causality in that study. There is no suggestion that MS causes Migraine disease or Migraine disease causes MS.
You can use any argument you want. My experience with VA health care is I try not to go there...ever. I have been out of the Navy since 92 and have had private heath care insurance since. Dealing with the VA is like dealing with social security. Logic rarely has much to do with the decisions. You have to keep going until you wear them down. They run like a heath care company and a benefits company rolled into one, and that creates conflicts of interest.
The link between migraine headaches and the diagnosis of Multiple Sclerosis is one of many conflicting factors in the difficult diagnosis of MS. More people with MS also get migraines, chronically severe or cluster headaches as compared with the general population according to the National MS Society. Since it is only one factor in MS diagnosis and since MS comes about differently in different people, it is not the deciding factor in MS diagnosis
Although most people are familiar with having a headache of some kind, those with MS have lesions on the brain combined with low serotonin levels--factors shared with migraine sufferers. According to the National MS Society, migraine headaches are a common but little studied link to the diagnosis of MS. The Society is helping fund a study at New York University to find out why migraines are more common in MS patients than in the general population.
I am a vet and wish I had not put so much trust in va doctors. I have not been dx with ms. I didn't even know what ms was until this past october.That is when I had an mri come back possitive for lesions consistant with ms. Since then neg spinal tap results, many blood tests all neg. My doctor had stated we will probably never know what I have and to stay off the internet.
>have had headaches almost constantly for years, and my MS specialist doesnt think they are part of the MS....
my non-VA neuro thinks they are linked or due to my cervical DDD or both. my VA docs won't say one way or the other. but they do that show for everything.
>This year my Dr. finally let me have some pain meds, and i take them too. I can't stand headaches. I also don't like taking the pills...
me too and as far as i can, my quality of life is a little better with the meds. though i would prefer not to take them and be in better health. thats just denial and wishful thinking that nothing is wrong with me. LOL
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