title: Headaches in multiple sclerosis: Cross-sectional study of a multiethnic population.
abstract: OBJECTIVE
  Headaches in MS are common, but there is little data on the influence of race, comorbidities, MS disability and socioeconomic issues on headaches, especially migraine. We aimed at looking at prevalence and type of headache across a multiethnic MS population, and relationship between MS related clinical factors and migraine.
  
  
  METHODS
  This is a cross-sectional study of 233 MS patients at two clinical sites, one at a county hospital, and the other a private academic center clinic. We collected demographic data, MS characteristics, and headache histories using validated survey instruments including Headache Impact Test (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). The relationship between MS and migraine was examined using logistic regression.
  
  
  RESULTS
  Majority of our patients were female (N=156, 67%), average age 44 years, with relapsing remitting MS (N=214, 92%). Our cohort was multi-ethnic predominantly Whites (N=106, 46%) and Hispanics (N=87, 37%). Public sector patients were significantly disadvantaged in socioeconomic measures (p<0.0001) and younger (40 vs 47 yrs, p<0.0001), compared to the private sector patients who had a higher MS burden. Headaches were common, regardless of sector (N=115, 49.4%), the most common type being migraine (N=83, 36%). Chronic migraine was more common among Hispanics (82%) than Whites (18.2%) (p=0.012). Headache impact on daily life, measured by HIT-6 score (p=0.006) and PHQ-9 score (p=0.004) were significantly higher in the public sector. After controlling for income and education, female gender (OR 2.59, 95% CIs 1.312-5.127) and ambulatory disability were found to be more likely to suffer from migraines.
  
  
  CONCLUSIONS
  Headache, especially migraine is common among MS patients regardless of socio-economic status and treatment setting. Female MS patients with walking disability and longer disease duration tend to get migraines. Hispanic MS patients have a higher likelihood of suffering from chronic migraines. Thorough headache evaluation and headache treatment are essential to comprehensive MS care.
authors.affiliation: Department of Neurology, USC Keck School of Medicine, Los Angeles, USA. Electronic address: sahai@usc.edu.
authors.forename: Soma
authors.initials: S
authors.lastname: Sahai-Srivastava
authors.affiliation: Department of Neurology, USC Keck School of Medicine, Los Angeles, USA.
authors.forename: Shirley L
authors.initials: SL
authors.lastname: Wang
authors.affiliation: Department of Neurology, USC Keck School of Medicine, Los Angeles, USA.
authors.forename: Ceren
authors.initials: C
authors.lastname: Ugurlu
authors.affiliation: Department of Neurology, USC Keck School of Medicine, Los Angeles, USA.
authors.forename: Lilyana
authors.initials: L
authors.lastname: Amezcua
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000208:ethnology*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000208:ethnology*; D011159:Population Surveillance / Q000379:methods
keywords: Demographics; Depression; HIT-6; Headache; Headache impact; Hispanic; Migraine; Multiple sclerosis