Neuropathic pain and migraine are common in patients with multiple sclerosis (MS). A study by Xavier Moisset and colleagues in Clermont-Ferrand University Hospital, France shows that these two pain types often coexist in patients with MS, but might have different mechanisms in this population.

Migraine headaches and pain with neuropathic characteristics are both more prevalent in patients with MS than in the general population. To determine the prevalence of these types of pain—both individually and in combination—in patients with MS, Moisset and his team used a postal questionnaire to survey a large group of French patients with well-defined MS in the MS patients' network in Auvergne.

Prevalence of pain types in patients with multiple sclerosis. Credit: Original image courtesy of X. Moisset.

The authors used the European Database for Multiple Sclerosis to ascertain patients' health status. Neuropathic pain was assessed with the DN-4 questionnaire, and migraine was identified according to the International Classification of Headache Disorders diagnostic criteria. The severity of pain was determined using the short form of the Brief Pain Inventory.

The overall prevalence of pain in patients with MS was 79%, but the prevalence of migraine was highest in patients who had neuropathic-type pain. Comorbidity of migraine and neuropathic pain was observed in 32% of patients, and was associated with increased intensity and severity of both pain types.

The researchers found that migraine, but not neuropathic pain, was linked to young age, short disease duration, a relapsing–remitting MS course, and interferon treatment. Similar risk factors for migraine in patients with MS were identified in a recent study by Jan Möhrke and colleagues.

“Migraine and neuropathic pain are co-occurrent, but the underlying mechanisms are probably distinct,” concludes Moisset. The authors plan to use imaging and electrophysiological methods to better understand the underlying mechanisms and improve therapeutic management of pain in patients with MS.