| Abstract [eng] |
While treating multiple sclerosis (MS), it is important not only to reduce the progression of the patient's disability, but also to manage co-existing diseases or conditions. One such condition is migraine, which is far more prevalent among individuals with MS compared to the general population. This master's thesis presents a narrative literature review discussing the latest information on the epidemiology, etiology, pathogenesis, clinical, diagnostic and therapeutic features of MS and migraine co-morbidity, and an illustrative clinical case study. Recent meta-analyses have shown that migraine has a prevalence of 24-31% in MS patients, with migraine without aura being the predominant form. The comorbidity of both diseases can be partly explained by a number of overlapping risk factors as well as several common pathogenesis theories and a few pathophysiological aspects. Clinically, suffering from both diseases is associated with a number of conditions that impair quality of life, such as chronic fatigue, cognitive impairment, poor sleep quality and depression. Migraine, similar to MS, is associated with white matter hyperintensities in the brain, which can cause difficulties in diagnosing MS itself and differentiating it from migraine with aura. In addition to other primary headaches, headaches induced by disease-modifying agents of MS are important for the differential diagnosis of migraine. There is no overlap between treating these two diseases, but non-specific prophylactic treatment for migraine should be tailored to the MS and selected according to the patient's individual characteristics. In the case report, a variant of atypical comorbidity between IS and migraine is presented. A female patient is diagnosed with late-onset primary progressive MS and migraine with aura and is treated with 2 monoclonal antibodies, ocrelizumab and fremanezumab, with little scientific evidence, regarding safety of the selected treatment. The clinical case discussion deepens the epidemiological and pathogenetic aspects discussed in the literature review and related to the case, discusses the diagnostic difficulties encountered and the recent evidence of efficacy and safety of the chosen migraine treatment. |
