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The Association of Brainstem Lesions With
Migraine-Like Headache: An Imaging Study of
Multiple Sclerosis
Gee JR, Chang J, Dublin AB, Vijayan N.
Posted: July 2005  
Headache 2005;45:670-677

Objective:   To determine if the prevalence of migraine-like headache I patients with multiple sclerosis (MS) is associated with plaques in the brainstem or in other locations.

Background:   There is increasing evidence to suggest that periaqueductal gray matter (PAG) plays a role in the pathophysiology of migraine headache. There are a few clinical case studies and some experimental evidence in support of this observation.

Methods and Results:   The study population of patients with demyelinating disease was identified by accessing the MRI database accumulated from 1992 to 2002. A total of 4369 MRI scan reports were available for review. Out of these, 1533 studies were reported to have possible demyelinating lesions. Medical records of these patients were reviewed to confirm the diagnosis of MS and also to document the headache complaints, if any. Two hundred and seventy-seven patients were identified with definite MS. 182 patients were diagnosed with remitting-relapsing MS, 47 with primary progressive MS, and 48 with secondary progressive MS. Overall, 154 patients had a complaint of headache. Of these patients, 95 met criteria for migraine-like headache, 39 met criteria for tension-type headache, and 20 had features of migraine and tension-type headache. MS patients with a plaque within the midbrain/periaqueductal gray matter areas had a four-fold increase in migraine-like headaches, a 2.5-fold increase in tension-type headaches and a 2.7-fold increase in combination of migraine and tension-type headaches when compared to MS patients without a midbrain/periaqueductal gray matter lesion. Although not statistically significant, MS patients with three or more lesion locations were found to be approximately two times more likely to have migraine-like headaches compared to MS patients with 0 to 2 locations. A linear trend was also observed between numbers of lesion locations and migraine-like headaches.

Conclusion:   The results of this study indicate that the presence of a midbrain plaque in patients with MS is associated with an increased likelihood of headache with migraine characteristics.