3 Types of MS-Related Headaches

Find out what causes this MS symptom and how to identify it

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Everybody has a headache occasionally; however, people with multiple sclerosis (MS) are much more prone to migraine-like or cluster headaches than the general population. Up to 58 percent of people with MS experience chronic or recurring headaches, compared to 16.5 percent of the general population. Of course, almost everyone (over 90 percent of people, MS or not) gets occasional headaches.

Headaches are a mystery.

But when they occur in someone experiencing MS, their causes are a bit more clear. Lesions, depression, or specific medications can all be possible triggers.

Types of MS-Related Headaches

There are three types of headache that are directly associated with multiple sclerosis:

Migraines are more common in people with relapsing-remitting MS. They last between 4 and 12 hours and tend to be:

  • Preceded by an aura (blurry or distorted vision signaling that a headache is about to begin) or prodrome symptoms (including fatigue, hunger or anxiety)
  • Throbbing on one or both sides of the head
  • Accompanied by sensitivity to light or sound
  • Typically accompanied by nausea, vomiting or loss of appetite
  • Followed by residual pain and discomfort

Some people find that a long nap — 5 or more hours — following a migraine helps relieve some residual symptoms.

Cluster headaches begin as a severe burning or stinging sensation on one side of the nose or deep in one eye.

They tend to last only 15 minutes or as long as 3 hours. Characteristically, the pain:

  • Peaks rapidly
  • Feels like electric shocks or “explosions” in or behind the eye
  • Occurs only on one side of the face
  • Comes on without warning (unlike many migraines)
  • Tends to recur at the same time every day (often soon after falling asleep), usually for a period of several weeks
  • Can cause eye to water, nose to run, or eyelid to droop
  • Completely resolves after headache (until next headache)

Tension-type headaches are the most common in the general population. Their duration can be 30 minutes to all day, and:

  • Rarely causing severe pain, more often moderate or mild
  • Feel like a constant, band-like aching or squeezing sensation that is either right over the eyebrows or encircling the head
  • Come on gradually
  • Can happen any part of the day, but usually occurs in the latter part of the day

What Causes Headaches in People with MS?

Many different things can cause headaches in people with MS, including:

Lesions: A study looking at 277 MS patients suggested an association between number of midbrain lesions and migraine headaches. Interestingly, cluster headaches in people with MS have also been shown to be linked with lesions in this area of the brain, where the trigeminal nerve, which is also called the fifth cranial nerve, originates. This is the nerve that is involved in the other “most painful MS symptom” – trigeminal neuralgia or tic doloureux.

Optic Neuritis: Headaches are also common during episodes of optic neuritis. These headaches are usually only on one side and worsen when then eyes are moved.

Depression: Depression, a very common MS symptom, has also been associated with headaches in people with MS. Depression and migraine headaches are both linked to low serotonin levels.

Medication Side Effects: The interferon-based disease-modifying therapies — Rebif, Betaseron and Avonex — can cause headaches or make pre-existing headaches worse. Provigil, Symmetrel and other drugs used for fatigue also have headaches as a primary side effect.

How Severe Can Headaches Get?

Headaches can be extremely disabling. Migraine headaches can be incredibly painful, and the accompanying light and sound sensitivity can lead to people withdrawing to a quiet, dark space for hours at a time. Even when the migraine has passed, people are often left with residual symptoms — called the postdome phase — which include fatigue, irritability, problems concentrating and dizziness.

Cluster headaches are often described by people as the worst pain they could ever imagine, akin to “a burning ice pick being plunged into their eye.” The pain from cluster headaches causes many people to fall on the floor, pull at their hair, bang their heads on the wall, rock back and forth, scream and weep. Although the pain from cluster headaches resolves — it has no lingering effect like with migraines — people often feel completely exhausted after each headache.

Just as disabling as the headaches is the fear and dread that people feel, knowing there is a good chance that another one is coming within hours or the next day. This anxiety can interfere with daily activities or social contact, as well as lead to insomnia, as people avoid falling asleep.

When to See Your Doctor

You should see your doctor for any type of unusual headache, a headache that keeps recurring, or one that lasts for a long time.

Before seeing him or her, take notes about your headache. It is helpful to keep a symptom log where you record the specifics of your headaches, including time of day they started, how long they lasted, any triggers that you might have noticed and anything that you did (including medications) that helped. This will help your doctor to determine what might be causing the headaches, what type they are and what kind of treatment to try.


Rae-Grant AD, Eckert NJ, Bartz S, Reed JF. Sensory symptoms of multiple sclerosis: a hidden reservoir of morbidity. Mult Scler. 1999 Jun;5(3):179-83.

Gee JR, Chang J, Dublin AB, Vijayan N. The association of brainstem lesions with migraine-like headache: an imaging study of multiple sclerosis. Headache. 2005 Jun;45(6):670-7.

Gentile S, Ferrero M, Vaula G, Rainero I, Pinessi L. Cluster headache attacks and multiple sclerosis. J Headache Pain. 2007 Sep;8(4):245-7.

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