Headache as a Symptom of Multiple Sclerosis

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

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Everybody has a headache occasionally. However, some research suggests that people with multiple sclerosis (MS) may be more prone to migraines and maybe other headache disorders, like tension headaches or even rarely, cluster headaches.

Types of MS-Related Headaches

There are three types of primary headache disorders that have been evaluated as being potentially linked to multiple sclerosis:

Migraines

Migraines are common in people with relapsing-remitting MS. They last between four and 72 hours and  have some of the following features:

  • 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
  • Accompanied by nausea, vomiting, or loss of appetite
  • Followed by residual pain and discomfort

Some people find that a long nap following a migraine helps relieve some residual symptoms.

Cluster Headaches

Cluster headaches begin as a severe burning sensation on one side of the nose or deep in one eye. They tend to last only 15 minutes or as long as three 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 eyes to water, nose to run, or eyelids to droop
  • Completely resolves (until the next cluster headache)

Tension-type Headaches

Tension-type headaches are the most common type of a headache in the general population.

Their duration can be 30 minutes to all day (or even up to one week). Tension-type headaches also:

  • Rarely cause 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 during any part of the day, but typically occur in the latter part of the day

What Causes Headaches in People With MS?

Many different things can cause headaches in people with MS, some more directly related to the disease itself than others.

These causes include:

Multiple Sclerosis Lesions

Some research in people with MS suggests an association between MS lesions in the brain and an increase in the number of migraines and/or tension-type headaches. In addition, there are reports of a headache or a migraine being the main symptom of a person undergoing an acute MS relapse. Lastly, one case report described worsening migraine symptoms as the initial manifestation of MS in a young woman.

Conversely, other research suggests that there is no link between migraines and tension-type headaches and MS. For example, one Norwegian case-control study administered a questionnaire to over 750 people with MS and over 1000 controls.

Results revealed no connection between migraines or tension-type headaches and MS.

Lastly, cluster headaches in people with MS have also been linked with lesions in the brainstem, especially in the 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 the affected eye is moved.

Depression

Depression, a 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 (e.g., Rebif, Betaseron, and Avonex) can cause headaches or make pre-existing headaches worse. Gilenya too, another MS disease-modifying medication, may cause headaches. Lastly, Provigil, Symmetrel, and other drugs used for fatigue also have headaches as a primary side effect.

How Severe Can Headaches Get?

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 postdrome phase—which includes 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 are 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.

A Word From Verywell

You should see your doctor for any type of an 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's 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.

Sources:

Applebee A. The clinical overlap of multiple sclerosis and headaches. Headache. 2012 Oct;52 Suppl 2:111-6.

Kister I, Caminero AB, Herbet J. Tension-type headache and migraine in multiple sclerosis. Curr Pain Headache Rep. 2010;14:441-48.

Gustavsen MW et al. Migraine and frequent tension-type headache are not associated with multiple sclerosis in a Norwegian case-control study. Mult Scler J Exp Transl Clin. 2016 Dec 12;2:2055217316682976.

Pelikan JB, McCombe JA, Kotylak T, Becker WJ. Cluster headache as the index event in MS: A case report. Headache. 2016 Feb;56(2):392-6.

Tabby D, Majeed MH, Youngman B, Wilcox J. Features and implications for disease management. Int J MS Care. 2013 Summer;15(2):73-80.