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Multiple Sclerosis and Headaches

As if living with a chronic autoimmune condition wasn’t headache enough, many people with Multiple Sclerosis (MS) are regularly struck down with real headaches, too. There is evidence to suggest that as MS progresses, headaches become more frequent1.

Though not considered a typical symptom of the condition, there’s evidence headaches occur more frequently in people with MS than the general population2, 3 . The type and severity of headaches varies from person to person; tension-type headaches (a dull ache across your forehead or on the sides and back of your head) and migraines without aura (usually one-sided throbbing headache associated with light sensitivity, noise sensitivity, nausea, and irritability) 4 tend to be the most commonly reported2.

For some people, headaches are the very first sign of MS2. One survey of 78 people with the condition, for example, found two thirds experienced headaches before they noticed any other signs of their condition3. The frequency of headaches also appears to vary – the same survey found half of the group with MS experienced headaches at least once a week3.

MS Migraine – Is it a thing?

There’s a clear link between migraines and MS. One study of more than 100,000 people found an association between migraines and an increased risk of MS5, while another found migraines were three times more common in people with MS6. In the small survey mentioned above, 43% experienced migraines accompanied by dizziness, blurred vision and tightness3. These migraines in particular, appear to be more common after a MS diagnosis, and for many people, worsen with relapse3.

Scientists don’t fully understand the link between headache and MS – whether the headaches are down to brain changes brought on by the condition or vice versa. We know, for example, that migraines are more commonly reported in relapsing forms of MS, while tension-type headaches are more frequent in progressive MS4. What’s more, headaches in people with MS appear to be more likely if there is brain stem involvement7, particularly a lesion in the periaqueductal grey matter – a region of the midbrain that plays a role in processing pain signals8. That said, there could also be something about migraines that makes the brain more susceptible to MS. We just don’t know yet.

In case you’re worrying that your migraines are a sign your MS is progressing, don’t. While it’s true that migraines are more common in people with more symptomatic MS, they don’t appear to be associated with a greater likelihood of disability or increased lesion load on MRI scans6.

Spotting and Avoiding Headache Triggers

That doesn’t mean a pounding head can’t still ruin your day – “fatigue, irritability, difficulty concentrating, and limitation of daily activities” are reported by up to a third of people when headaches strike, with 39% requiring rest during relapses3.

Taking note of what brings on your headaches can be helpful – common triggers include bright light, loud noises, certain foods– so avoiding these will hopefully reduce the frequency and severity of relapses. Some women also notice a monthly pattern to migraines, in which case they may be linked to their periods (apps like Period Tracker or Clue can be helpful for determining this)3.

Whether you can spot an obvious trigger or not, it’s definitely worth discussing the problem with your doctor. He or she will be able to advise you on the best forms of pain relief for when headaches do strike.

Finally, next time your temples are throbbing, be kind to yourself. Don a pair of sunglasses, grab a duvet, hit the sofa and give yourself permission to take time out. There are no trophies for headache heroics – although if there were, you’d probably have a trophy case full by now!

References:

  1. Headache in Multiple Sclerosis: Features and Implications for Disease Management. David Tabby, DO, Muhammad Hassan Majeed, MD, Branden Youngman, DO et al. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883008/
  2. Headache in multiple sclerosis and autoimmune disorders. La Mantia L, Prone V. Neurol Sci. 2015 May;36 Suppl 1:75-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26017517#
  3. Headache in Multiple Sclerosis. Features and Implications for Disease Management. David Tabby, Muhammad Hassan Majeed, Branden Youngman, and Jessica Wilcox. Int J MS Care. 2013 Summer; 15(2):73–80. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883008/
  4. Headache, hmm? Barts MS Blog Friday, 29 May 2015. Blog citing “Headache in multiple sclerosis and autoimmune disorders. La Mantia L et al.” http://multiple-sclerosis-research.blogspot.com/2015/05/headache-hmm.html
  5. Increased risk of multiple sclerosis among women with migraine in the Nurses' Health Study II. Kister I, Munger KL, Herbert J, Ascherio A. Mult Scler. 2012 Jan;18(1):90-7. 3. http://www.ncbi.nlm.nih.gov/pubmed/21816759
  6. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. Kister I, Caminero AB, Monteith TS, Soliman A, Bacon TE, Bacon JH, Kalina JT, Inglese M, Herbert J, Lipton RB. J Headache Pain. 2010 Oct;11(5):417-25. http://www.ncbi.nlm.nih.gov/pubmed/?term=20625916
  7. The Association of Brainstem Lesions With Migraine-Like Headache: An Imaging Study of Multiple Sclerosis. Joey R. Gee DO, Joyce Chang MS, Arthur B. Dublin MD and Nazhiyath Vijayan MD. Headache: The Journal of Head and Face Pain. Volume 45, Issue 6, pages 670–677, June 2005. http://www.ncbi.nlm.nih.gov/pubmed/?term=15953299
  8. Functional characteristics of the midbrain periaqueductal gray. Behbehani MM1. Prog Neurobiol. 1995 Aug;46(6):575-605. http://www.ncbi.nlm.nih.gov/pubmed/8545545
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