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headaches and MS
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headaches and MS

are headaches a symptom of MS? that is, recognized by the med community?

i have a vet friend whom is getting the run around from the VA regarding his headaches. he is dx with MS but the VA won't recognize headaches/migraines as a secondary issue.

he is willing to travel to see a neuro who does recognize this symptom of MS and be evaluated.

if any of you know such a good doctor please let me know ...  thx
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Avatar_f_tn
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..
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572651_tn?1333939396
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
http://msj.sagepub.com/content/14/9/1157.full.pdf+html

I hope your headaches get better soon!
Lulu
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Avatar_f_tn
I don't know anyone who DOESN'T get headaches (I mean in person, not in here) !

Mine drive me mad - seems I have typical and atypical migraines, tension headaches, hormonal headaches - and they all started only a few years ago with the MS.

'International panel of experts' HA!
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1453990_tn?1329235026
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."
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572651_tn?1333939396
Thanks, Bob, for that eloquent explanation.  Wouldn't  that be secondary or tertiary symptoms of the disease but not primary symptoms?  

The problem  headache is there not because of the MS itself, but a side effect of all the crazy things that happen with this disease.  
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1453990_tn?1329235026
I like your summary.  My brain doesn't break it down on the way to the keyboard.
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1221035_tn?1301004108
Here are just a few of many articles on Migraines and MS:

http://www.associatedcontent.com/article/2710481/neurologists_link_migraines_and_multiple.html

******
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1453990_tn?1329235026
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.

Bob
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Avatar_m_tn
do you have a link to the article(s) you are reading? i can send that to my vet buddy.

thx
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Avatar_m_tn
Lu & Bob,

secondary is what my vet buddy is needing. that is his on going headache issues, which have helped contribute to his disability, "are more likely than not" due to his MS.

>>While this doesn't excuse poor care for MS patients, you may need to lead them through the steps.

Bob, you have any links supportive enough for my friend to print and take to his neuro so he can lead them through some steps?  thank you
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Avatar_m_tn
although daisy-girls link is about a study with females only couldn't my vet buddy use that study to help with getting one of his secondary MS isssues (disabling headaches) listed?

at the least it is some ammunition?
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1453990_tn?1329235026
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.  
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1221035_tn?1301004108
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.

Read more: http://www.livestrong.com/article/15980-early-symptoms-ms-migraine-headaches/#ixzz1B13LTBbh

Here's hoping that maybe this article too will help your friend. Maybe contact the NMMS too.
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Avatar_f_tn
  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.
bridgeport
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620048_tn?1358021835
I have had headaches almost constantly for years, and my MS specialist doesnt think they are part of the MS....They are not migraines  but seem to me to be associated with my eyes.

Drs don't seem to want to deal with headaches at all, when I saw my MS DR. last time she referred to the Headache clinic at UCSF but they have not called me yet.

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...

meg
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Avatar_m_tn
>> There is no link of causality in that study.  There is no suggestion that MS causes Migraine disease or Migraine disease causes MS.  

good point, thank you.

>>They run like a heath care company and a benefits company rolled into one, and that creates conflicts of interest.  

wow, exactly what my brain says all the time but my words have yet to put it so concise and to the correct point.

thank you for the perspecitive
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Avatar_m_tn
i can empathize with you, believe me.

they did the same to me for 24 years. used every excuse and side-stepping trick in the book to not diagnose me.

only until i drained my savings with non-VA docs and presented that data to my C&P exam did they diagnose me and service connect it..

there is some merit to reading into stuff too much with all the data out there. BUT, if not for this site and 2 other vet sites that deal with VA and MS issues i'd be just another casualty of the VA.

stick around and educate yourself
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Avatar_m_tn
>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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911669_tn?1294102788
Thank you for the information.....

One of my first symptoms were migraines.....

I feel for every one having that kind of pain....

terri
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