Is headache a common symptom in Miller Fisher Syndrome? – Two Case Reports

Miller Fisher syndrome (MFS) is an acute demyelinating disorder that is considered a cranial nerve variant of Guillain-Barré syndrome (GBS). The pathophysiological process behind MFS is immune-mediated nerve damage but there is some debate with regards to whether this is primarily due to central nervous system (CNS) or peripheral nerve involvement. Headache has been described more frequently in MFS than in GBS however it still remains a rare occurrence with few published case reports. In this review we describe two patients diagnosed with MFS in which headache was a prominent and persistent feature. Our patients were both male aged 37 and 38 years respectively with no relevant medical co-morbidities. Both cases of MFS were accompanied by severe headaches requiring regular analgesia for a prolonged period of time. The pathophysiology of headache in MFS is still uncertain but there are a number of postulated mechanisms described in the literature which we have explored in relation to our cases.