Treatment of Headaches and Migraines in MS

How Your Doctor Will Take Your MS into Account when Treating Your Headaches

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For most cases of MS-related headaches, the treatment is the same as it would be in people without MS. However, it's important to see your neurologist, as certain drugs may work better for your headaches, depending on the cause.

It's also possible that some of the medications that you are currently taking for your MS or MS symptoms could be causing the headaches, in which case the doctor may want to alter how you take them, change to another drug, or have ideas on how to cope with this side effect.

In addition, there are some drugs used to treat headaches that have side effects that can make MS symptoms feel worse.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) to Treat Headaches

NSAIDs, such as naproxen (Aleve) and ibuprofen (Advil or Motrin) may help your tension headaches and migraines and are often recommended first, especially for mild pain. Some people cannot take NSAIDs though, so it's important to consult your doctor first, even though many NSAIDs are available over-the-counter. 

Antidepressants to Treat Headaches and Migraines in MS

Some people may require treatment with antidepressants, as depression (a very common MS symptom) has also been associated with migraines in people with and without MS. Depression and migraines  are both linked to low serotonin levels. Examples of antidepressants sometimes used to treat both depression and migraines include:

  • The tricyclic antidepressant Elavil (amitriptyline). This is an older drug and may not be the best option for a person with MS due to its potential for side effects including drowsiness, constipation, or difficulty passing urine. 
  • The serotonin norepinephrine reuptake inhibitor (SNRI) Effexor (venlafaxine) may be effective in both preventing migraines and treating depression. 
  • Selective serotonin reuptake inhibitors (SSRIs) are often quite effective in treating depression, but not as much in preventing migraines. That being said, some doctors will prescribe it, especially if they believe a person's headaches are really stemming from a person's depression. 

    Treating Migraines in MS with Triptans

    Triptans are used to treat moderate to severe migraines in people with and without MS. They bind to serotonin receptors in the brain, which works by blocking certain pain pathways and narrowing blood vessels. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Related medications include rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax).

    Steroids to Treat Headaches in MS

    If your headache is related to an MS relapse, like when a lesion on an MRI correlates with the area of head pain, or when a person is having a bout of optic neuritis, a course of Solu-Medrol may be effective in resolving the symptoms.

    Bottom Line

    Treating your headaches and migraines may require a bit more thought than someone who does not have MS -- and this is okay. There are excellent headache therapies out there so you can get relief and get on with your day. 


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    Pöllmann W, Feneberg W. Current management of pain associated with multiple sclerosis. CNS Drugs. 2008;22(4):291-324.

    DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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