ClinicSpeak: migraine headaches and MS

Did you know if you have MS you have more than a 1 in 3 chance of being a migraineur? #ClinicSpeak #MSResearch #MSBlog

“How many of you suffer from headache? Did you know that migraine headache is much commoner in pwMS than in the general population? Why? It now become evident that in migraine is much more common in people who have brain disease in general. It seems as if focal pathology, particularly in the hypothalamus and brainstem areas of  the brain, may trigger migraine. In the study below 36% of pwMS had migraine; this is consistent with other studies and is about double the background risk in the general population. The fact that it is so common means that we should probably include headache on our scorecards when we review pwMS to make sure we are not missing headache. Clearly headache is a very common comorbidity in MS and may be contributing to poor quality of life.”

“If you don’t manage migraine properly you can convert it into a chronic daily headache,  usually as a result of analgesic misuse, that is very difficult to treat. If you have migraine, or frequent headaches, please discuss this with your neurologist so that you can get proper advice and treatment for your headaches. To make things easier for your neurology team I suggest starting a headache diary to document the frequency and severity of your headaches and how they respond to treatments. The management of migraine is broken-up into three classes of treatment; (1) prophylactic therapies, or strategies, to reduce the frequency of headaches, (2) abortive treatments to try a get rid of the migraine before it builds to a crescendo, these treatments are typically given after the onset of the headache and (3) symptomatic treatments, these treatments are given once the migraine is established, i.e. analgesics and antiemetics for the nausea.”

“Would you like a more detailed post on the management of migraine headache in MS, including self-management strategies?”

Epub: Sahai-Srivastava et al. Headaches in multiple sclerosis: Cross-sectional study of a multiethnic population. Clin Neurol Neurosurg. 2016 Feb 1;143:71-75. doi: 10.1016/j.clineuro.2016.01.017. 

OBJECTIVES: Headaches in MS are common, but there is little data on the influence of race, comorbidities, MS disability and socioeconomic issues on headaches, especially migraine. We aimed at looking at prevalence and type of headache across a multiethnic MS population, and relationship between MS related clinical factors and migraine.

PATIENTS AND METHODS: This is a cross-sectional study of 233 MS patients at two clinical sites, one at a county hospital, and the other a private academic center clinic. We collected demographic data, MS characteristics, and headache histories using validated survey instruments including Headache Impact Test (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). The relationship between MS and migraine was examined using logistic regression.

RESULTS: Majority of our patients were female (N=156, 67%), average age 44 years, with relapsing remitting MS (N=214, 92%). Our cohort was multi-ethnic predominantly Whites (N=106, 46%) and Hispanics (N=87, 37%). Public sector patients were significantly disadvantaged in socioeconomic measures (p<0.0001) and younger (40 vs 47 yrs, p<0.0001), compared to the private sector patients who had a higher MS burden. Headaches were common, regardless of sector (N=115, 49.4%), the most common type being migraine (N=83, 36%). Chronic migraine was more common among Hispanics (82%) than Whites (18.2%) (p=0.012). Headache impact on daily life, measured by HIT-6 score (p=0.006) and PHQ-9 score (p=0.004) were significantly higher in the public sector. After controlling for income and education, female gender (OR 2.59, 95% CIs 1.312-5.127) and ambulatory disability were found to be more likely to suffer from migraines.

CONCLUSION: Headache, especially migraine is common among MS patients regardless of socio-economic status and treatment setting. Female MS patients with walking disability and longer disease duration tend to get migraines. Hispanic MS patients have a higher likelihood of suffering from chronic migraines. Thorough headache evaluation and headache treatment are essential to comprehensive MS care.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Thank you for this post. I prefer to say that headaches were my first official MS symptom. I used to get headaches that would come on suddenly with great intensity in the middle of the night. It felt like someone was stabbing my head with an ice pick. (sorry for the gross description). My neurologist diagnosed it as hypnic headaches and suggested treatment, which luckily worked. Or perhaps, they just waned as I got over that particular relapse, who knows!

  • This post is really helpful and I would be very grateful if you could do a future post on this and self-management. I have been getting migraines for the last few years which my neurologist knows about. More recently however I have been getting quite frequent visual migraines where I completely lose my vision for a short while but no headache at the end – am reporting this to my neurologist but I wonder if this type of migraine is also common amongst pwMS?

  • I had regular (several per month), severe migraines following onset of MS in 2000, which resulted in time off work and a lot of paracetamol + ibuprofen use. But these migraines reduced drastically, have all but stopped after cutting out eggs and going vegan. I doubt that my GP or neurologist would ever have suggested this. They would have just suggested some drugs. Which is why never even bothered asking them about it. I'm not saying this will work for everyone, but it's too easy to dismiss diet/allergies/intolerances as factors which can make a _huge_ difference.

    • I was given a list of foods and drink by my neurologist and GP that could bring on migraines. I tried and some did cause the headaches. I still suffered for years, but I knew some of the triggers. Migraines as with MS don't affect us in the same way and the causes will be different. I would suggest to anyone suffering and it is so unbearable, to keep a diary and food record. You may see a pattern that is individual to you.

  • I've had migraines with aura since I was very young (3 or 4)but since my MS diagnosis I have also experienced ocular migraines. These only last between 5-15 minutes and I don't experience a headache but the visual disturbance (like a whiteout) is much more severe while it lasts. Mostly it just affects one eye but on one occasion it affected both eyes.

  • My migraines used to be infrequent but severe and they lasted 3 days.

    After being prescribed a triptan I can almost always get the headache to stop: but the frequency has gone up, and every now and then I get into a chronic daily headache stage, which forces me to eliminate the tablets for a while

  • Is it possible for migraines to be triggered by MS activity?

    I have identified some migraine triggers, but sometimes I get a migraine that seems unrelated to any trigger.

  • My first migraine was six months prior to my first MS attack. I suffered for years. Following major surgery(unrelated) the migraines stopped. Not had one for ten years after suffering 30 years.

  • Very interesting that there is an association between migraines and MS. Migraines are considered by many to be a vascular problem and reversed by constriction with ergot therapies. Migraines sufferers also have very similar findings to MS patients on MRI. Hmmm maybe researchers in MS are barking up the wrong tree and MS is possibly a neuro-vascular problem and not just a neuro-immune problem?

  • "The fact that it is so common means that we should probably include headache on our scorecards when we review pwMS to make sure we are not missing headache."

    Well, most blockbuster drug trials dismiss headache as an endpoint. Here is a trial of balloon angioplasty with huge impact on migraine. Yes, it is all about venous drainage and guess what: focal pathology has little to do with that.

By Prof G



Recent Posts

Recent Comments