Mid-term Improvement of Persistent Headaches in Patients with Multiple Sclerosis Underwent Balloon Venoplasty of Internal Jugular Veins

Introduction - While many reports link headaches with obstruction of the cerebral venous drainage pathways, there are no studies specifically investigating the relationship between obstructive disease of the IJVs and headaches. This is the first report evaluating the role of the balloon venoplasty of Internal Jugular Veins (IJVs) in the treatment of patients with persistent headache and Multiple Sclerosis (MS). Methods - This open label observational study, with data collected prospectively, was designed to evaluate, using a standardized and operator-indipendent catheter venography protocol, the impact of venoplasty on headaches in patients with MS. From May 2011 to December 2015, 113 MS patients, diagnosed with obstructive disease of IJVs and persistent headache (82 Relapsing Remitting, 22 Secondary Progressive, and 9 Primary Progressive) underwent bilateral IJVs balloon venoplasty. In all patients the severity of headache was documented using the Migraine Disability Assessment (MIDAS) before venoplasty, 3-months after venoplasty, and at final follow-up in 2017. Patients were evaluated with Doppler sonography of the IJVs before, at 1, 6 and 12 months after venoplasty and yearly thereafter. Non-parametric statistical analysis was performed using a combination of the Friedman test and Spearman correlation analysis. Results - With the exception of the PP patients there were significant reductions (all p < 0.001) in the MIDAS score in the 3-month following PTA. The clinical improvement in MIDAS score following venoplasty was maintained throughout the follow-up period in both the RR (p < 0.001; mean of 3.55 years) and SP (p = 0.002; mean of 3.52 years) MS cohorts (Figure 1). Furthermore post-venoplasty MIDAS score was significantly negatively correlated with the change in the blood flow score in the left (r = -0.238, p = 0.031) and right (r = -0.250, p = 0.023) IJVs in the RR patients and left IJV (r = -0.727, p = 0.026) in the PP patients. Conclusion - This study documented for the first time a large and sustained (>3 years) reduction in MIDAS score in both RR and SP MS patients undergoing IJVs venoplasty. The results of this study are promising and suggest that balloon venoplasty might be a useful intervention for treating MS patients with selected obstructive disease of the IJVs who currently suffer of headache with little relief.