Headache as a Symptom of Multiple Sclerosis

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

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Everybody has a headache occasionally. However, research suggests that people with multiple sclerosis (MS) are 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 a headache associated with multiple sclerosis:

Migraines are common in people with relapsing-remitting MS. They last between 4 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 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 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 (until the next cluster headache)

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 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: One study looking at people with MS suggested an association between brainstem lesions and an increase in the number of migraines and 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. That being said, another study in Current Pain and Headache Reports did not find a link between the location or number of MS lesions and people with or without certain types of headaches—so the jury is still out on this precise connection. 

On another note, cluster headaches in people with MS have also been 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 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 (for example, 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 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.

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.

Sources:

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

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.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

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

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

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