Relative frequency of primary headaches in patients with neuromyelitis optica spectrum disorder: A cross-sectional study

Abstract

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD. Methods: This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3). Results: Eighteen patients (15) reported headaches, all of whom were women. The average age of these patients was 41.27 +/- 11.33 years, and the average onset age of NMOSD was 34.60 +/- 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 +/- 1.42) than those with tension headaches (4.20 +/- 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis. Significant associated symptoms included photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57 of migraine sufferers and 50 of tension headache sufferers. Conclusion: Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.