Treating Headaches and Migraines in MS

How Treatment Can Vary in People with Multiple Sclerosis

Headaches can happen to anyone, but some studies have suggested that people with multiple sclerosis (MS) are twice as likely to have headaches or migraines than the general population. Some research has even suggested that the severity of headaches may be amplified as a result of MS, wherein damage to certain nerve cells can make a bad situation even worse.

A migraine with aura.
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Causes of Headache and Migraines

In most cases, the treatment of headache for people with MS is the same as it would be for anyone else. The one exception may be the types of drugs used to treat MS, some of which are associated with headache.

For example, steroids used to treat MS relapses can sometimes cause elevated blood sugar which, in turn, can trigger headaches and other diabetic symptoms. Similarly, some of the disease-modifying medications used to treat MS may result in flu-like symptoms, including headaches.

Types of Headaches and Migraines

In order to effectively treat a headache, a doctor will first need to determine which type is it. By definition, a headache is the symptom of pain occurring anywhere in the region of the head or neck. It may be experienced in a number of different ways:

  • Migraines are pulsating, typically one-sided headaches lasting from four to 72 hours.
  • Tension headaches are described as a continual nagging and pressing pain.
  • Cluster headaches are much rarer and are described as a sharp pain on one side of the head that can come and go, often associated with eye pain.

Treatment Options

Doctors will treat headaches based on the cause. If the headache is the result of a drug side effect, the doctor may be able to substitute the offending drug or change the dosage. At other times, pain-killers may be prescribed to help alleviate the symptoms.

Among some the more commonly prescribed options:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen) and Advil or Motrin (ibuprofen), are usually the first-line defense is treating tension headaches and migraines.
    • Antidepressants, used to treat symptoms of depression common in people with MS, may also help treat migraines. Since both depression and migraines are linked to low serotonin levels, restoration of those levels may improve both symptoms over time. Options include:
      Effexor (venlafaxine), a serotonin norepinephrine reuptake inhibitor (SNRI)
    • Selective serotonin reuptake inhibitors (SSRIs) are less effective in treating migraines but may be prescribed if the doctor believes the pain is stemming from the person's depression.
  • Triptans are class of drugs used specifically to treat migraines and cluster headaches. They bind to serotonin receptors in the brain, blocking certain pain pathways and narrowing blood vessels.
  • While high-dose steroids can cause headaches in some, the same drugs can be effective in treating headaches related to MS relapse. If headaches are associated with optic neuritis or induced by an MS lesion, a course of Solu-Medrol can often help alleviate chronic or acute headache pain.
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  • Tabby, D.; Hassan Majeed, M.; Youngman, B. et al. "Headache in Multiple Sclerosis: Features and Implications for Disease Management." Int J of MS Care. 2013; 15(2):73-80.