When listing the common symptoms of multiple sclerosis (MS), migraine attacks aren’t usually included. However, some research has suggested that people with MS have a higher incidence of certain headache conditions, like migraine.
While migraine is fairly common, multiple sclerosis is not. About
Research studies have estimated that migraine affects about 31 percent to 35 percent of people with MS. This is close to three times the prevalence of migraine in the general population.
Many people with migraine don’t have MS, while people with MS may or may not experience migraine attacks. What exactly does this mean? Keep reading below as we break down the similarities between MS and migraine, how they may be related, and more.
There are several similarities between MS and migraine. Let’s explore these now.
MS and migraine are both neurological conditions. A neurological condition is one that impacts your nervous system. In the case of MS and migraine, the central nervous system, which is made up of the brain and spinal cord, is affected.
Both MS and migraine are chronic health conditions. This means that they’re persistent or long-lasting. Chronic conditions often require ongoing medical care, and many can have a significant impact on an individual’s daily life.
Both MS and migraine symptoms can come on in attacks. Between these attacks is typically a period of remission. It’s important to note that the term “attack” means something different for each condition.
In MS, an exacerbation is a period in which symptoms temporarily worsen before returning to their normal level. These are also called relapses or flares. An example of a type of MS where this is common is relapsing-remitting MS, which makes up
However, not all types of MS are associated with attacks. For example, primary progressive MS is characterized by MS symptoms that continue to gradually worsen over time.
In migraine, an attack is when you feel acute symptoms like throbbing or pulsing headache pain, sensitivity to light, and nausea. Some individuals with migraine may also experience a collection of symptoms called aura prior to a migraine attack.
MS relapses and migraine attacks can both be brought on by a variety of triggers. These can include both physical and environmental factors.
Some potential triggers for MS relapses are:
- increased stress
- missed MS medication doses
A few typical migraine triggers include:
- increased stress
- insufficient sleep
- hormonal fluctuations, such as those during the menstrual cycle or during pregnancy
- changes in weather
- certain foods or drinks, such as:
- aged cheese
- cured meats
- salty foods
- caffeinated beverages
- foods containing additives such as monosodium glutamate (MSG) and aspartame
- some medications like oral contraceptives and vasodilators
You may wonder if MS can cause migraine attacks.
Generally speaking, the majority of people with MS and migraine received a migraine diagnosis prior to an MS diagnosis. This leads researchers to believe that MS doesn’t cause migraine.
However, a relationship does exist. An MS lesion in the periaqueductal gray matter (PAG) — an area of gray matter found in the midbrain — can cause migraine in some people.
MS medications as a trigger for migraine attacks
We mentioned earlier that certain types of medications may lead to migraine attacks in some individuals. There are a few medications that are used to treat MS that may exacerbate headaches, possibly triggering migraine attacks in the process. These MS medications include:
- beta interferon
- fingolimod (Gilenya)
- natalizumab (Tysabri)
It’s possible for migraine to be misdiagnosed as MS. A misdiagnosis of migraine as MS can have several significant health effects, such as:
- receiving years of unnecessary MS treatment
- experiencing psychological stress from receiving an MS diagnosis
- delay of effective migraine treatment
A 2019 study looked at the prevalence of MS misdiagnosis in two medical centers over 12 months. It found that, out of 241 individuals attending either clinic for MS treatment, 18 percent were misdiagnosed. Of these individuals, 16 percent actually had migraine.
Further, a 2016 study evaluated 110 people with MS misdiagnoses. In addition to noting that migraine was the most common alternative diagnosis, the researchers also found that:
- For 36 of these individuals (33 percent), the length of their misdiagnosis was 10 years or longer.
- A total of 77 people (70 percent) received unnecessary treatment for MS, with 34 individuals (31 percent) experiencing unnecessary side effects.
- Four participants (4 percent) had participated in a clinical trial for MS treatment.
Why does this happen?
Generally speaking, misdiagnosis may happen because of findings on an MRI scan. For example, someone with migraine may have lesions that appear very similar to those associated with MS.
A 2013 study looked at people that received an MRI for a headache and had no previous history of a demyelinating disease like MS. After evaluating MRI scans from these individuals, it was found that 24.4 to 34.5 percent of the MRI scans met parts of the McDonald criteria for MS diagnosis.
Additionally, a doctor may also consider symptoms that are atypical for MS as a part of the diagnostic process, resulting in a misdiagnosis. This includes the symptoms of migraine.
While many people with MS may experience migraine, headache isn’t typically one of the early signs of MS. Instead, symptoms to keep an eye out for include:
- muscle weakness, particularly in the hands or legs
- muscle stiffness, which can occur with muscle spasms
- feelings of numbness or tingling in areas like the arms, legs, or face
- trouble with coordination or balance
- issues with vision, such as blurry vision, double vision, or optic neuritis
- problems with bladder control (incontinence)
Treatments are generally based on what’s causing migraine. For example, if you’ve been prescribed fingolimod — a disease-modifying therapy (DMT) for MS — and find that it triggers migraine attacks, your doctor might alter the dosage or prescribe a substitute.
Migraine medications are classified into two categories:
- Abortive medications help to ease the symptoms of an acute migraine attack.
- Preventive medications work to prevent migraine attacks from occurring.
A few examples of medications that can be used to either treat or prevent migraine in people with MS include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter (OTC) painkillers such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are often the initial treatments for mild migraine attacks.
- Triptans. Triptans can be used to treat migraine attacks and are available in many forms, such as pills, nasal sprays, injections, and dissolvable tablets. Some examples of triptans include:
- rizatriptan (Maxalt)
- almotriptan (Axert)
- sumatriptan (Imitrex)
- Antidepressants. Many people with MS also experience depression and may be prescribed antidepressants. Antidepressants can also be used as effective prevention of migraine attacks. Venlafaxine (Effexor) is one example.
If you have MS, you may be more likely to experience migraine attacks than someone without MS. But there’s currently no medical consensus regarding the relationship between MS and migraine.
It’s possible that future research may find a specific relationship. However, more research is needed.
In the meantime, if you have MS and experience migraine attacks, talk with your doctor about possible triggers, what you can do, and treatment options for managing both.