Assessment of different types of headaches, their prevalence, and contributing factors on neuromyelitis optica spectrum disorder patients.

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.