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Headache in Radiologically Isolated Syndrome: A Hint Toward Imminent Conversion: A Case Report Publisher Pubmed



Etemadifar M1 ; Kaveyee H1 ; Zohrabi P1 ; Jozaie AM1 ; Salari M2 ; Ebnealiheydari Y1
Authors
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Authors Affiliations
  1. 1. School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Journal of Medical Case Reports Published:2025


Abstract

Background: Headaches are more prevalent in patients with multiple sclerosis compared with the general population. However, headaches are still considered a rare symptom of multiple sclerosis, especially when they appear as an initial symptom. The occurrence of a headache as a symptom of radiologically isolated syndrome (RIS) is uncommon, and it can significantly increase the likelihood of developing multiple sclerosis. Case presentation: We report the case of a 36-year-old Iranian woman experiencing severe unilateral headaches without other multiple sclerosis symptoms. Despite normal physical and laboratory exams, cerebrospinal fluid analysis showed positive oligoclonal bands. Magnetic resonance imaging (MRI) revealed multiple demyelinating plaques consistent with RIS. She was treated with dimethyl fumarate. Subsequent MRI confirmed multiple sclerosis by showing new gadolinium-enhanced lesions. After 3 months of dimethyl fumarate treatment, her headache intensity decreased, and she remained otherwise symptom free. Written informed consent was obtained from the patient. Conclusion: Effectively managing headaches in patients with RIS is a challenge for clinicians to improve their quality of life and delay the progression of multiple sclerosis. © The Author(s) 2025.
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