Headache and multiple sclerosis: comorbid emotional and insomnia disorders

Multiple sclerosis (MS) is often accompanied by various neurological disorders, including headache, which is common among patients with MS, but its relationship with other comorbid conditions such as depression and insomnia remains poorly understood.

The aim. To assess the incidence of headache in patients with MS, and to examine the incidence and severity of emotional disorders (depression, anxiety) and insomnia in patients with MS.

Material and methods. The study included 60 patients who were divided into 3 groups of 20 people each. The fi rst group consisted of patients with MS complaining of headache, the second group (comparison group) consisted of patients with multiple sclerosis without headache. The control group consisted of 20 patients with primary headache (tension headache and migraine). A numerical pain rating scale was used to assess headache intensity. Emotional disorders were assessed using the Beck Depression Inventory and the Spielberger–Hanin Anxiety Scale, and the severity of sleep disorders was assessed using the Pittsburgh Sleep Quality Index Questionnaire. Descriptive statistics methods were used for statistical analysis. Quantitative indicators with a normal sample distribution were described using arithmetic means (M) and standard deviations (SD). Comparison of percentages in the analysis of multifield contingency tables was performed using the Pearson chi-square test. Differences were considered statistically significant at p < 0.05.

Results. The average severity of headache according to the digital pain rating scale was 5.42 ± 1.34 points (the fi rst group — 5.75 ± 1.33, the control group — 5.10 ± 1.29, p = 0.126), which corresponds to moderate severity of cephalalgia. It was found that the presence of headache is associated with an increased level of depression and anxiety, as well as with an increase in the number of cases of insomnia. Statistically significant differences in the severity of depression between the first and control groups were noted (p < 0.001), with a greater number of patients with MS and concomitant headache experiencing depression, and also more often demonstrating a high level of situational and personal anxiety. The intensity of headache correlates with the severity of situational and personal anxiety. Sleep problems are more common in patients with MS with headache, while sleep disorders increase with the growth of neurological deficit.

Conclusion. The obtained data indicate the need for a comprehensive approach to the treatment of patients with MS, including assessment and correction of not only the main neurological symptoms, but also concomitant emotional and insomnia disorders. Headache may be considered as an important indicator of the patient's general condition and the potential risk of developing the studied comorbid conditions.

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