Surreal illustration of a brain with optic nerves and spinal cord, partially obscured by a distorted lens.

Headache or Something More? How to Spot Misdiagnosed Neuromyelitis Optica

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Don't let a headache mask a serious condition. Learn about neuromyelitis optica (NMO) and how to recognize its early signs."

Headaches are a dime a dozen. Most of us have experienced the throbbing, aching, or squeezing sensation that can disrupt our day. We pop a painkiller, maybe drink some water, and hope it fades away. But what if that headache isn't just a headache? What if it's a symptom of something far more serious?

Neuromyelitis optica (NMO), also known as Devic's disease, is a rare autoimmune disorder that affects the central nervous system, primarily the optic nerves and spinal cord. Because its initial symptoms can mimic other conditions, including common headaches, NMO is often misdiagnosed, leading to delays in treatment and potentially devastating consequences.

This article aims to shed light on NMO, its symptoms, and the importance of early diagnosis. We'll explore a real-life case where NMO was initially mistaken for a cervicogenic headache, highlighting the subtle clues that can help doctors and patients identify this often-overlooked condition.

What is Neuromyelitis Optica (NMO)?

Surreal illustration of a brain with optic nerves and spinal cord, partially obscured by a distorted lens.

Neuromyelitis optica (NMO) is an inflammatory autoimmune disease where the body's immune system mistakenly attacks healthy cells in the optic nerves and spinal cord. This can lead to a range of neurological problems, including:

The condition is characterized by relapses, where symptoms flare up and then subside, but each relapse can cause further damage. Early diagnosis and treatment are crucial to prevent permanent disability.

Optic neuritis: Inflammation of the optic nerve, causing blurred vision, eye pain, and even vision loss.
Myelitis: Inflammation of the spinal cord, leading to weakness, numbness, and paralysis in the limbs, as well as bowel and bladder dysfunction.
Headaches: While not always present, headaches can be a symptom of NMO, particularly cervicogenic headaches caused by neck pain and stiffness.

NMO is often confused with multiple sclerosis (MS) because both diseases involve inflammation and damage to the central nervous system. However, NMO is distinct from MS and requires different treatment approaches.

The Takeaway: Listen to Your Body and Advocate for Your Health

While neuromyelitis optica is rare, this case underscores the importance of being vigilant about your health and advocating for yourself when something doesn't feel right. Don't dismiss persistent or unusual symptoms as "just a headache." If your headaches are accompanied by vision changes, numbness, weakness, or other neurological problems, seek medical attention promptly and be sure to share your complete medical history with your doctor. Early diagnosis and treatment can make a significant difference in the long-term outcome of NMO.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3344/kjp.2014.27.1.77, Alternate LINK

Title: A Case Of Neuromyelitis Optica Misdiagnosed As Cervicogenic Headache

Subject: Anesthesiology and Pain Medicine

Journal: The Korean Journal of Pain

Publisher: Korean Pain Society

Authors: Soo Il Choi, Yeon Ju Lee, Do Wan Kim, Jong Yeun Yang

Published: 2014-01-31

Everything You Need To Know

What exactly is Neuromyelitis Optica (NMO), and what parts of the body does it affect?

Neuromyelitis Optica (NMO), also known as Devic's disease, is a rare autoimmune disorder targeting the central nervous system. Specifically, it primarily affects the optic nerves and the spinal cord. In NMO, the body's immune system mistakenly attacks healthy cells in these areas, leading to inflammation and damage. This can result in a range of neurological problems. While headaches can be a symptom, especially cervicogenic headaches, NMO mainly manifests as optic neuritis (inflammation of the optic nerve), causing vision issues, and myelitis (inflammation of the spinal cord), leading to weakness and numbness. It is important to distinguish NMO from multiple sclerosis (MS), as they require different treatments.

Why is Neuromyelitis Optica (NMO) often misdiagnosed, and what are the potential consequences of a delayed diagnosis?

Neuromyelitis Optica (NMO) is frequently misdiagnosed because its initial symptoms, such as headaches, can mimic more common conditions. The delay in proper diagnosis stems from the subtle presentation and the overlap with other disorders. Delayed diagnosis can have potentially devastating consequences. Because NMO is characterized by relapses, each flare-up can cause further damage to the optic nerves and spinal cord. Without early diagnosis and appropriate treatment, this can lead to permanent disability, including vision loss, paralysis, and bowel and bladder dysfunction. Early intervention is crucial to minimize long-term neurological damage.

Beyond headaches, what are the key symptoms that might indicate Neuromyelitis Optica (NMO) rather than a more common ailment?

While headaches, particularly cervicogenic headaches, can be a symptom, several other key symptoms are more indicative of Neuromyelitis Optica (NMO). These include optic neuritis, which involves inflammation of the optic nerve, leading to blurred vision, eye pain, and potential vision loss. Myelitis, or inflammation of the spinal cord, can cause weakness, numbness, and paralysis in the limbs, as well as bowel and bladder dysfunction. The presence of these symptoms alongside headaches should raise suspicion for NMO and prompt further investigation to differentiate it from other conditions.

How does Neuromyelitis Optica (NMO) differ from multiple sclerosis (MS), and why is it important to distinguish between the two?

Neuromyelitis Optica (NMO) and multiple sclerosis (MS) are both inflammatory diseases affecting the central nervous system, which can lead to confusion in diagnosis. However, NMO is distinct from MS and requires different treatment approaches. The key difference lies in the specific targets of the immune system and the patterns of damage in the brain and spinal cord. While both can cause similar symptoms, the underlying mechanisms and the specific antibodies involved differ. Accurate differentiation between NMO and MS is critical because the treatments used for MS may not be effective for NMO and could potentially worsen the condition. Therefore, proper diagnostic testing is essential.

What steps should someone take if they suspect they might have Neuromyelitis Optica (NMO), especially if they are experiencing persistent headaches along with other neurological symptoms?

If you suspect you might have Neuromyelitis Optica (NMO), particularly if you are experiencing persistent or unusual headaches accompanied by other neurological symptoms like vision changes, numbness, weakness, or bowel and bladder dysfunction, it is crucial to seek prompt medical attention. Share your complete medical history with your doctor and clearly articulate all of your symptoms. Given that NMO is rare, it's important to advocate for yourself and ensure that your doctor considers NMO as a potential diagnosis. Early diagnosis and treatment can significantly improve the long-term outcome and prevent further damage to the optic nerves and spinal cord.