Does Multiple Sclerosis Cause Headaches?

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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.

Headache Types

There are three types of primary headache disorders that have been evaluated as being potentially linked to multiple sclerosis: migraines, cluster headaches, and tension headaches.

According to the Centers for Disease Control and Prevention (CDC), women are twice as likely to experience headaches, migraines, and severe jaw of facial pain (a characteristic symptom of MS) than men.

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 Headaches

Tension headaches are the most common type of 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

Symptoms

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 episode 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.

Causes

Many different things can cause headaches in people with MS, some of which are directly related to the disease and others of which are residual side effects of treatment.

MS 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.

Cluster headaches have been linked to MS lesions in the brainstem, especially in the part where the trigeminal nerve originates. This is the nerve involved with one of the most painful MS symptoms, known as trigeminal neuralgia.

Other studies suggest there is no link between MS and either migraines or tension headaches. One case-control study in Norway involving over 1,750 participants found that there was no increased risk of migraines or tension headaches in people with MS compared to the general population.

MS Medications

The interferon-based disease-modifying therapies (Rebif, Betaseron, Avonex) can cause headaches or make pre-existing headaches worse. Gilenya, another MS disease-modifying medication, may cause headaches. So can Provigil, Symmetrel, and other drugs used to treat MS-associated fatigue.

Other Causes

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, 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.

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.

When to See a Doctor

Call your doctor is a headache is severe or persistent, causes nausea or vomiting, or interferes with your ability to function, see, speak, think, or sleep.

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