Pediatric Onset Multiple Sclerosis and Primary Headache: Is There a Link?

Background: Pediatric-onset Multiple Sclerosis (POMS) is a rare but often more aggressive form of multiple sclerosis, associated with early cognitive impairment and significant impact on quality of life. While the relationship between multiple sclerosis and primary headaches, especially migraine, is well-established in adults, data on pediatric populations remain limited. Methods: this retrospective study analyzed 64 POMS patients, divided into groups with and without headaches, to explore potential associations between headache presence, age at POMS onset, and MRI lesion burden. Results: headaches were reported by 78% of patients, predominantly migraines (68%), with a significantly higher prevalence in females (74%). No significant differences were found in age at MS onset or lesion load on brain MRI between patients with and without headaches. Among those with headaches, migraineurs experienced a higher frequency of attacks and a greater need for prophylactic treatment compared to other headache types. Headache characteristics, including pain location and associated symptoms, showed no correlation with age at MS onset or lesion burden. Conclusions: these findings indicate that while headaches are common in POMS and more frequent in females, their presence and features do not appear to directly influence the clinical or neuroradiological course of the disease. Further research with larger cohorts and longitudinal follow-up is warranted to better understand the underlying mechanisms and long-term impact of headaches in pediatric MS.