Objective:

To identify clinical risk factors for increased headache frequency in patients with multiple sclerosis (PwMS). 

Background:

PwMS are more likely to experience headaches than the general population. However, risk factors for headache frequency in the MS population are not well established, and elucidating clinical risk factors for more frequent headaches is crucial for identifying those who may need treatment.

Design/Methods:

We used multivariate logistic regression to examine relationships between demographic and clinical data, MS severity indicators, and self-reported headache frequency in PwMS. We report odds ratios (OR) for experiencing at least one headache per month and their 95% confidence intervals (CIs).

Results:

We included 241 PwMS; 55.6% reported at least one headache per month. Female sex (OR, 2.56; 95% CI 1.35-4.88; p=0.004), non-white race (OR, 3.65; 95% CI 1.30-10.30; p=0.014), depression (OR, 1.78; 95% CI 1.01-3.16; p=0.046), history of tobacco use (OR, 1.91; 95% CI 1.08-3.38; p=0.026), and MS family history (OR, 2.59; 95% CI 1.24-5.41; p=0.012) all significantly increase risk of experiencing monthly headaches in PwMS, while higher EDSS decreases risk (OR, 0.83; 95% CI 0.70-0.98; p=0.031). Age, medication possession ratio (a measure of MS treatment history), and MS duration did were not significantly associated with monthly headaches in our cohort.

Conclusions:

In conclusion, non-white race, female sex, depression, tobacco use, and MS family history significantly increase the risk of monthly headaches in PwMS, while higher EDSS decreases risk. The association with non-white race highlights another disparity within this population, emphasizing the role of social drivers of health in headache risk. These findings underscore the need for targeted interventions and proactive screening in those with these headache risk factors.