Prevalence and Clinical Phenotypes of Headache in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: The MOGHEAD Study.

BACKGROUND

Headache associated with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is poorly characterized.

OBJECTIVE

To investigate the prevalence, clinical phenotypes, and longitudinal evolution of headache in MOGAD.

METHODS

In this single-center retrospective cohort study based on prospectively collected clinical data, consecutive adult patients diagnosed with MOGAD between 2020 and 2024 were enrolled. Demographic, clinical, and radiological data were collected. Headaches were classified according to the International Classification of Headache Disorders. Patients underwent quarterly evaluations over 1 year. Pain severity was assessed using the Numeric Rating Scale at baseline and at the 1-year visit, while headache-related disability was assessed using the Migraine Disability Assessment at the 1-year visit in patients reporting headache.

RESULTS

Twenty-two patients were included (median age 35 years; 54.5% male). Headache occurred in 54.5% at onset and 68.2% after 1 year. Pre-existing primary headache disorders were present in 54.5%. Headaches showed heterogeneous features, commonly retro-orbital or unilateral frontal pain with pulsating or pressure-like quality and associated photophobia/phonophobia. Migraine was the predominant phenotype at 1 year. Headache characteristics evolved over time in 73.7% of the cases, while 50% reported inadequate response to symptomatic therapy. Female sex, pre-existing headache, and rituximab exposure were associated with headache persistence in univariable analyses.

CONCLUSIONS

Headache is common in MOGAD, often pre-existing, with heterogeneous phenotypes, although its clinical burden and evolution over time remain incompletely characterized. New-onset retro-orbital headache may represent a clinical red flag requiring further investigation.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07479212.