The importance of headaches in multiple sclerosis is largely neglected as focal neurological symptoms such as optic neuritis, paresthesia or weakness of organs has become the main focus of conce rn. Studies indicate a prevalence of 43% for migraine in patients with MS, which is higher than general population. Therefore, this study emphasizes on the importance of headache in MS patients and its precise workup, as well as timely management of headaches in MS.
In the current study, we examined a 49-year-old patient with sudden throbbing headache that worsened with movement, photophobia and phonophobia, concomitant with non-pulsating tinnitus and true vertigo. In the physical examinations, we found a preceding decrease in the force of the right upper limb and the left lower limb since a long time before. CT scan and MRI of the brain was performed. CT scan showed evidence of periventricular and centrum semiovale lucency, and MRI findings along with clinical observations were consistent with RRMS. Periventricular and pericerebellar plaques with Gad Enhancement were evident. During the admission for headache, the patient was hypertensive and received amlodipine, metoral and valsartan. His headache was treated with acetaminophen and vitamin B. The headache was successfully controlled, and the blood pressure decreased. Furthermore, due to a recent evidence of tinnitus and true vertigo, pulse corticosteroid therapy and dimethyl fumarate were administered for MS attack.