Assessment of Different Types of Headaches, Their Prevalence, and Contributing Factors on Neuromyelitis Optica Spectrum Disorder Patients Publisher



P Sharifi PARISA ; M Togha MANSOUREH ; Ma Sahraian Mohammad ALI ; Z Ebadi ZAHRA ; NULL ; A Moradi AMIR ; NULL ; A Nasermoghadasi ABDOREZA
Source: Multiple Sclerosis and Related Disorders Published:2025

Abstract

Background: Headaches are an underrecognized burden in Neuromyelitis Optica Spectrum Disorder (NMOSD), yet their prevalence, types, and contributing factors remain poorly characterized. Methods: In this cross-sectional study (February 2023–2024), 84 NMOSD patients (81 % female; mean age 39.3 ± 8.8 years) from a tertiary center in Tehran, Iran, were evaluated. Headaches were classified per ICHD-III criteria using validated questionnaires, and magnetic resonance imaging (MRI) findings were assessed by specialists. Logistic regression identified associations between headaches and clinical/radiological variables. Results: Headaches affected 91.6 % of patients (77/84), with migraines (63.6 %) and tension-type headaches (36.4 %) most prevalent. Frontal (74 %) and temporal (72.7 %) regions were commonly involved. Cervical longitudinally extensive transverse myelitis (58.3 %) and subcortical lesions (21.4 %) predominated. Abnormal MRI findings (80.5 % vs. 42.8 %, p = 0.043) was more observed among patients with headache. Additionally, new-onset/worsened headaches post-diagnosis correlated with MRI abnormalities (OR: 6.85; 95 % CI: 1.46–32.09, p = 0.015) and rituximab therapy (OR: 2.77; 95 % CI: 1.05–7.29, p = 0.039). No associations were found with age, gender, or seropositivity. Conclusion: Headaches-particularly migraines-are highly prevalent in NMOSD and linked to structural CNS changes and rituximab use. These findings underscore the need for integrated headache management in NMOSD care. © 2025 Elsevier B.V., All rights reserved.