Reviewed by Dr Jason Ray MBBS FRACP, Neurologist and Headache Sub-Specialist, Alfred Health and Austin Hospital.
Headaches are the most common neurological condition and a leading cause of neurological disability, and many people with MS experience headaches that significantly impact their quality of life.
There are several different types of headaches, and there are certain types of headaches that research studies have linked to multiple sclerosis. The most commonly linked type of headache in MS is a migraine. Other types of headaches that people with multiple sclerosis seem slightly more prone to are cluster headaches, tension-type headaches, and trigeminal neuralgia.
If you or someone you care about are experiencing headaches that impact your day-to-day life, speak to your GP (general practitioner), MS nurse or neurologist. They can help you find answers and manage your symptoms.
Headaches are very common in the general population, making it challenging to establish a direct connection with MS. Many studies have shown people with multiple sclerosis are more likely to also experience a headache disorder. The most common type of headache linked to MS is migraine. For people with multiple sclerosis experiencing headaches, it is commonly a process to determine if the headache is related to MS or another condition.
Headache disorders are divided into two different categories:
Researchers are continuing to study what the causes are of headache disorders that relate to multiple sclerosis. It is important to speak to your doctor about your headaches to determine their cause and the best approach to limit their impact.
Migraine, and in particular migraine with aura, is associated with an increased chance of developing ‘spots’ in the brain that may be seen on MRI (Magnetic Resonance Imaging) scans.
These can generally be differentiated from MS lesions by your doctor, and in contrast to multiple sclerosis lesions, migraine spots are not associated with any disability, change in cognition or disease activity.
According to some studies and reports:
It is important to work with your health care team to ensure that other factors are excluded before concluding that the headache is caused by multiple sclerosis. For example, it may be a medication causing the headache, and a change of medication resolves the headaches.
Even if the headaches are originally due to MS, in general, headaches without other symptoms are not a common indicator of multiple sclerosis disease activity. It is important to manage headaches and limit their impact as they can cause similar symptoms to MS, such as fatigue and pain.
Triggers can be the same for both headaches and worsening multiple sclerosis symptoms (e.g., stress and some medications). This is also true of the protective factors (e.g., exercise and a healthy diet), making it important to continue to focus on brain health.
If your MS symptoms are worsening or you’re worried you’re having a relapse, speak to our MS nurses or your healthcare team.
In the day leading up to your headache, you may notice several symptoms as you start to experience your migraine. These can include a sensitivity to light or sound, fatigue, irritability, change in mood, excessive yawning or even food cravings and neck stiffness.
Approximately one third of people with migraine can experience a migraine aura. You may not have a migraine aura with every headache. A migraine aura is most commonly a visual disturbance such as bright zigzag lines or the perception of a kaleidoscope in the corner of your vision which lasts 20-45 minutes.
Less commonly, auras may include sensory symptoms such as tingling or numbness, motor weakness or speech disturbance. In contrast to an MS relapse, migraine auras are generally short lasting, occur prior to a headache (although not always), and follow a similar pattern.
The pain associated with a migraine is often one sided and of moderate to severe intensity, throbbing or pulsating and aggravated by movement. A migraine headache lasts between 4 and 72 hours, or longer in some cases.
A migraine is associated with at least one of the following symptoms:
Following the resolution of the pain, if you suffer a migraine, it is common to continue to experience symptoms for up to 2 days following. The symptoms in the ‘postdromal’ phase are often similar to those in the prodromal phase, and include difficulty concentrating, fatigue and change in mood.
A cluster headache is an excruciating headache. As opposed to a migraine, it occurs always on one side of the head, typically behind one eye or the side of the head. Individual attacks last up to three hours, and generally occur in intermittent ‘clusters’ more commonly in the evening and with a change in season.
Cluster headaches often make you feel restless and that you want to keep moving. The affected eye may be sensitive to light, and the affected side of the head develops ‘autonomic’ symptoms. These symptoms could include redness of the eye, tearing of the eye, congestion of the nose or flushing/sweating of one side of the face.
Cluster headaches can be more common in younger people or those in the earlier stages of MS. Cluster headaches have different treatments to migraine, so it is important to talk to your treating team if you have these symptoms.
Tension headaches cause pain behind the eyes and in the head and neck, which can be mild, moderate or severe. It could feel like a dull head pain, with pressure or tenderness in and around the forehead.
Unlike migraines, tension headaches generally don’t cause nausea or vomiting. Milder tension headaches are more common in people who have had multiple sclerosis for many years.
There are three ‘pillars’ to helping reduce the impact of your headaches if you have MS.
In some cases, you may be able to identify a trigger for your headaches. This could include stress, fatigue, anxiety, or a particular food or drink. Therapies that help to manage stress, or related mental health conditions such as meditation or counselling may be helpful.
You can make some healthy lifestyle changes which can also be positive for your multiple sclerosis, including:
If you suffer from headaches, it is useful to have an ‘action plan’ for how to manage the pain when one occurs. There are several medications that are effective at treating headaches that may be appropriate for different people. If taken too often they can worsen your headaches, so it is important to discuss this with your healthcare team.
If you are having headaches every week, or if your individual headaches are difficult to control and are impacting you, there are medications that can help reduce the frequency of your headaches which you can discuss with your doctor.
The statistics cited in this article have been sourced from the following studies:
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