Migraines and MS

Migraines and MS

Last updated: June 2022

Several studies have found an increased incidence of migraines among people with MS, suggesting that there may be a link between the two conditions. People with MS also have an increased incidence of headaches, although research has found a range from 4% to 58% prevalence over a person’s lifetime. MS patients with migraines also may experience more clinical symptoms over the course of their disease than those who don’t have migraines. However, researchers have yet to find a common factor in MS and migraines. Migraines are fairly common, occurring in approximately 40 million Americans. Some of those people also have MS, and some doctors suggest that the two diagnoses might just happen to the same person.1,2

What is a migraine?

Migraines are more than just a headache. Migraines are characterized by severe head pain, usually experienced on one side of the head (although they can be on both sides at the same time). They generally last for more than four hours if not treated and get worse with activity. Migraines are also often accompanied by nausea and extreme sensitivity to light and sound. Some people have warning signs prior to a migraine in the form of visual symptoms, called auras.2

MS treatment and migraines

Several medications used to treat MS have been shown to exacerbate headaches, and migraines may be triggered by disease-modifying treatments, like the beta interferons and Gilenya® (fingolimod). People without a prior history of migraines who take disease-modifying treatments for their MS may develop headaches as a possible side effect of the treatment, but these usually improve over time as the body gets used to the treatment. For people who have a history of migraines, the treatments may be a trigger, just as they might experience triggers like certain foods, changes in the weather, or hormonal fluctuations (like menstruation).2

Migraines versus MS lesions on the optic nerve

Some people with MS develop lesions on their optic nerve, which transmits signals from the eye to the brain. This is called optic neuritis (inflammation of the optic nerve), resulting in eye pain, as well as mild to severe vision loss and impaired color vision. Patients who have also experienced eye pain due to migraines might confuse the cause of this particular pain. Optic neuritis is the presenting symptom in 20% of MS patients, although it can occur without MS as well.2

MS lesions may cause migraines

In MS, the nerves are attacked by the immune system, causing damage to the protective outer myelin sheath (demyelination). The three most common sites for the demyelination seen in MS are the brainstem, the spinal cord, and the optic nerve. Migraines are believed to be triggered in the brainstem, and MS lesions in this area may cause migraines.2

Migraines as a sign of MS relapse

Migraines with aura and sharp pain may be a sign of a relapse of MS, and patients experiencing migraines should be evaluated so the appropriate treatment can be given. Patients who experience migraines often experience an increase in migraines during flares of MS. However, patients with a history of migraines may also experience them separate from flares of MS. Proper evaluation by a neurologist is needed to determine the cause and guide treatment.1,2

Getting help for migraines with MS

People with MS who experience migraines should talk to their neurologist about their experience. Research has shown that some doctors don’t routinely ask about migraines, and patients must speak up about migraines to ensure they get the attention they deserve. The right treatment can reduce the frequency or severity of migraines, which can lead to an improved quality of life, and in some patients, effective treatment for migraines means the ability to remain employed.1

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