Multiple sclerosis (MS) is a chronic demyelinating disease, and it is the most common immune-mediated inflammatory disease of the central nervous system (Ghasemi et al., 2017). According to the World Health Organization/Multiple Sclerosis International Federation (WHO/MSIF) MS Atlas, 2.3 million people worldwide were affected by MS in 2013, making it the most extensive global study to date (Bezzini, D. et al. 2020).

MS typically presents with symptoms such as visual disturbances, paresis with spasticity, paresthesia, numbness, and fatigue (Moreno-Torres et al., 2019). However, several studies have shown a high prevalence of headaches in MS (Kister et al., 2010; Beckmann and Türe, 2019). Migraine and tension-type headache are the most common types of headaches experienced by MS patients. According to multiple studies, 19.8–82 % of MS patients report migraine (Vacca et al., 2007; Nicoletti et al., 2008) and 12.2–55.2 % report tension-type headache (D'Amico et al., 2004; Villani et al., 2008).

MS lesions, especially those located in the brainstem, have been found to be frequently linked to migraine-type headaches. It is important to also consider the impact of MS disease-modifying drugs. These medications have varying modes of action and side effect profiles and may even trigger headaches in MS patients (Villani et al., 2012). Proper evaluation of headaches in MS patients is essential in order to optimize patient care and enhance quality of life (Husain, F et al. 2018).

This study describes the characteristics of primary headaches in a sample of Egyptian patients with multiple sclerosis. The relationship between headache and clinical features of MS (Course of MS, duration, EDSS, brain imaging and DMD) are also investigated.