C is for Comorbidities Willeke on MS and Related Conditions

As part of our A to Z of MS series, Willeke discusses C is for comorbidities.

The National Library of Medicine (NIH) defines comorbidities as "any additional disease that coexists in an individual with a given index disease and that is not an obvious complication of the index disease".

Everyone who has experienced headaches understands that they can vary greatly in type and intensity, often stemming from a multitude of causes, and it can be a frustrating and painful experience.

Migraines, the type of headaches that usually annoy only half of your brain, can be debilitating and turn your daily life upside down. People who live with migraines know that disturbed sleeping patterns, increased stress levels and changes in diet can cause them.

As a teenager, I began experiencing migraines on the left side of my head. Twenty years later, multiple sclerosis and trigeminal neuralgia followed suit. When I started experiencing the latter two - MS and TN - I initially thought they were mere migraines and, as such, not the end of the world. I never considered that this new pain could be something far worse.

When piercing pain in and around my left eye, ear and temple were joined by migraine, it felt like an all-out assault on my senses. Having lived with migraines for over a decade, its symptoms had become easily recognisable. Any new symptoms were recorded in my journal to help pinpoint what triggered them over a set period of time. I hoped that these would overlap with the ones I already identified and also turn out to belong to migraine.

That was sadly not the case.

These days, I clearly know what is a migraine spell and what is a trigeminal neuralgia attack. Rarely do I feel unable to differentiate, but if this happens, the answer will be provided by the specifically prescribed medicines for both conditions.

Adapting to pain

I'm now 20 years into my life with MS and have learned to adapt to these aches and pains in ways that don't knock me out mentally. Pain signals that your body needs attention, so it’s important to focus on effective pain management. Take the time to listen to your body, understand what’s going on internally and create treatment plans you can rely on, especially when additional health issues arise.

There are so many ways to learn to adjust to chronic symptoms, but the first step is often the most difficult to achieve, especially if you have a busy daily routine. When a migraine or trigeminal neuralgia attack happens, I force myself to take a step back from what I'm doing, find a place to rest, and allow the pain to subside, whether or not I use medication. If this is not achievable, I’ve learned through experience that multiple sclerosis will react to my stress levels, making the headaches even harder to manage.

Luckily, both MS and migraines benefit from a few similar lifestyle adjustments, like stress management, exercise, a balanced diet, and maintaining good sleep hygiene.

I continually tell myself that while MS is a chronic condition that remains a part of my life, migraine episodes have a shorter lifespan. They offer moments of relief that allow me to focus on enhancing my quality of life. This is especially important as studies indicate that those living with migraine are more sensitive to mood disorders like depression, anxiety, frustration, isolation, and helplessness - emotional challenges that stem from the unpredictability of migraine spells. Take it from someone who's lived with both conditions for over two decades, nothing is more important than making meaningful lifestyle changes that can make you more resilient and up to fight another day.

Further research from 2024, however, shows that comorbidities hurt clinical outcomes in multiple sclerosis (MS), including the severity of disability at diagnosis and threat of disability worsening after diagnosis. Addressing and preventing comorbidities should, therefore, be an urgent priority. This, I must say, is something that I didn't see coming, as my priorities were targeted at managing my MS first and anything else (much) later.