Prodromal headache in MOG-antibody positive optic neuritis

Susanna Asseyer; Josh Hamblin; Silvia Messina; Romina Mariano; Nadja Siebert; Rosie Everett; Wilhelm Küker; Judith Bellmann-Strobl; Klemens Ruprecht; Sven Jarius; Maria Isabel Leite; Alexander U Brandt; Friedemann Paul; Jacqueline Palace

doi:10.1016/j.msard.2020.101965

Prodromal headache in MOG-antibody positive optic neuritis

Mult Scler Relat Disord. 2020 May:40:101965. doi: 10.1016/j.msard.2020.101965. Epub 2020 Jan 25.

Affiliations

¹ Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
² Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
³ Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany.
⁴ Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany.
⁵ Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Germany.
⁶ Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK. Electronic address: maria.leite@ndcn.ox.ac.uk.
⁷ Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neurology, University of California, Irvine, CA, United States.
⁸ Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany.

PMID: 32062443
DOI: 10.1016/j.msard.2020.101965

Abstract

Background: Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) disease is an inflammatory autoimmune condition of the central nervous system, defined by antibodies (Abs) against MOG. Of the various clinical phenotypes optic neuritis (ON) is the commonest. We have observed that some patients with MOG-Ab ON present with a severe associated headache.

Objective: To highlight the importance of headache in MOG-Ab related optic neuritis.

Methods: Clinical and MRI data from MOG-Ab patients with ON (n = 129) were obtained from observational cohort studies and clinical notes at the NeuroCure Clinical Research Center, Charité Berlin and at the Diagnostic and Advisory Service for Neuromyelitis Optica, John Radcliffe Hospital, Oxford.

Results: Sixty-four of 129 MOG-Ab patients (49.6%) reported ≥1 headache-related ON. Headache usually started a few days prior to visual loss and extended from the ocular region to the periorbital and fronto-temporal area, sometimes mimicking migraine. Of those, thirty-two patients (50%) reported severe headache. Two patients did not have headache. No headache history was recorded for 63 patients. MRIs performed acutely during headache-related MOG-Ab ON (n = 15) showed anterior ON with extensive swelling and edema of the optic nerve/s in all patients, either unilaterally (n = 5) or bilaterally (n = 10). Peri-optic cerebro-spinal fluid (CSF) was undetectable due to the inflammatory extension in 12 out of 15 patients.

Conclusion: Our findings indicate that acute MOG-Ab ON shows florid intra-orbital and peri‑optic inflammation, likely to involve meninges and nociceptive fibers around the optic nerve. This may explain the frequent and often severe headache that precedes the visual deficit, sometimes misdiagnosed as migraine.

Keywords: Headache; MOG; Migraine; Myelin oligodendrocyte glycoprotein-antibody; Optic neuritis; Pain.

Publication types

Observational Study

MeSH terms

Adult
Child
Cohort Studies
Female
HEK293 Cells
Headache / etiology*
Humans
Inflammation / diagnostic imaging*
Magnetic Resonance Imaging
Male
Middle Aged
Myelin-Oligodendrocyte Glycoprotein / immunology*
Optic Neuritis / complications*
Optic Neuritis / diagnostic imaging*
Optic Neuritis / immunology*
Prodromal Symptoms*
Vision Disorders / etiology*
Young Adult

Substances

MOG protein, human
Myelin-Oligodendrocyte Glycoprotein