Overview of Multiple Sclerosis Headaches

Some studies show that people with multiple sclerosis (MS) are more likely to develop migraines and other headache disorders, such as tension or cluster headaches, than the general population.

One study found that 78% of newly diagnosed MS participants reported having a headache in the past month.

type of headache

Three types of primary headache disorders have been evaluated for possible association with multiple sclerosis: migraine, cluster headache, and tension headache.

According to the Centers for Disease Control and Prevention (CDC), women are twice as likely as men to experience headaches, migraines, and severe jaw or facial pain—the hallmark symptoms of MS.


Migraine headaches are common in people with relapsing-remitting MS.They last from 4 to 72 hours and have some of the following characteristics:

  • Prodromal symptoms (including fatigue, hunger, or anxiety) or aura (blurred or distorted vision, indicating that a headache is about to begin)
  • Jumping 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 taking a long nap after a migraine helps relieve some residual symptoms.

cluster headache

Cluster headaches start with a sharp throbbing, tingling, or burning sensation on the side of the nose or deep in one eye. They only last 15 minutes or up to three hours.

Typically, pain:

  • peak quickly
  • feeling like an electric shock or an “explosion” in or behind the eye
  • only occurs on one side of the face
  • Comes on without warning (unlike many migraines)
  • Tends to relapse at the same time each day (usually shortly after falling asleep), usually lasting several weeks
  • May cause watery eyes, runny nose, or droopy eyelids
  • Complete resolution (until next cluster headache)

tension headache

Tension headaches are the most common type of headache in the general population. They can last anywhere from 30 minutes to a full day (even up to a week).

Tension-type headaches also:

  • Rarely causes severe pain; it is usually moderate or mild
  • What feels like a constant, band-like pain or squeezing, either just above the eyebrows or around the head
  • Take it easy
  • Can occur at any time of the day, but usually occurs in the second half of the day
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Migraines can be incredibly painful, and the accompanying light and sound sensitivity can cause people to hide in a quiet, dark space for hours at a time.

Even after a migraine attack has passed, people are often left with residual symptoms — called the prodromal phase — including fatigue, irritability, difficulty concentrating, and dizziness.

Symptoms of a migraine attack

People often describe cluster headaches as the worst pain they can imagine, similar to sticking a burning ice pick into their eye. Their agony left many falling to the floor, pulling their hair, rocking back and forth, screaming and crying.

While the pain of a cluster headache subsides and doesn’t have the lingering effects of a migraine, people often feel completely exhausted after each headache.

As frustrating as a headache is the fear and dread of knowing that there is a good chance another person will come. This anxiety can interfere with daily activities or social contacts and lead to insomnia.


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

MS lesions

Several studies have shown an association between MS lesions in the brain and an increased number of migraines and/or tension-type headaches.In addition, some people who experience acute MS relapses report headaches or migraines as the main symptom.

Cluster headaches are associated with MS lesions in the brainstem, particularly in the part of trigeminal origin.This is the nerve associated with trigeminal neuralgia – one of the most distressing symptoms of MS.

However, other studies have shown no link between MS and migraines or tension headaches.

A case-control study of more than 1,750 participants in Norway found no increased risk of migraine or tension headaches in people with MS compared with the general population.

multiple sclerosis drugs

Interferon-based disease-modifying therapy may cause headaches or make pre-existing headaches worse. These drugs include:

  • Rebif (Interferon ß-1a)
  • Betaseron (Interferon ß-1b)
  • Avonex (Interferon ß-1a)

Other disease-modifying medications can also cause headaches, including:

  • Gironya (Fingolimod)
  • Provigil (modafinil)
  • Symmetrel (Amantadine)
  • Other medicines used to treat MS-related fatigue
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Headaches are also common during an optic neuritis attack. These headaches usually occur on only one side and get worse when the affected eye is moved.

Depression, a common MS symptom, is also associated with headaches. Both depression and migraines are associated with low serotonin levels.

When to see your healthcare provider

You should see your healthcare provider for any type of unusual headache, headache that recurs, or headache that lasts for a long time.


When evaluating your headache, your healthcare provider may start by asking you a few specific questions about your headache to narrow down the diagnosis. These questions include:

  • Location: Where is the pain?
  • PEOPLE: How would you describe your headache? (eg throbbing, pain, burning, sharpness)
  • Severity: On a scale of 1 to 10, how much is your pain, with 10 being the worst pain in your life? Would you describe your headache as mild, moderate or severe? Is this your biggest headache?
  • Aggravating or Relieving Factors: What Makes Pain Better or Worse?
  • Radiation: Does pain radiate?
  • Onset: Is your headache onset fast or gradual?
  • Duration: How long did the pain last? Is it constant or intermittent?
  • Lenovo: Are there other symptoms of your headache? (eg nausea, vomiting, visual changes)

Additionally, your healthcare provider will record your personal and family medical history, any medications you are taking, and your social habits (eg, caffeine intake, alcohol consumption, smoking).

If an extremely severe headache occurs suddenly and has not occurred before, brain imaging tests may be done to rule out a tumor or stroke.

Headache Evaluation and Diagnosis


A healthcare provider treats headaches based on the cause. If the headache is the result of a medication side effect, your healthcare provider may be able to substitute the offending medication or change the dosage.

At other times, pain medication may be prescribed to help relieve symptoms.

Commonly prescribed options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen) and Advil or Motrin (ibuprofen), are often the first line of defense for tension headaches and migraines.
  • Antidepressants called serotonin norepinephrine reuptake inhibitors (SNRIs), including Effexor (venlafaxine). Both depression and migraines are associated with low serotonin levels, so providing more serotonin to the brain may improve both symptoms over time.
  • Triptans are medicines that are specifically used to treat migraines and cluster headaches. They bind to serotonin receptors in the brain, blocking certain pain pathways and narrowing blood vessels.
  • High-dose steroids can cause headaches in some people, but the same drugs can be effective in treating headaches associated with MS relapses. If the headache is related to optic neuritis or caused by MS lesions, a course of Solu-Medrol can often help relieve chronic or acute headaches.

VigorTip words

It can be helpful to keep a symptom log where you can record specifics of your headache, including:

  • time they started
  • how long did they last
  • any triggers you may have noticed
  • anything that helps, including medication

This will help your healthcare provider determine what may be causing the headache, the type of headache, and which treatments to try.

Frequently Asked Questions

  • Can multiple sclerosis cause headaches?

    People with MS are more likely to experience headaches than the general population. Migraine, in particular, is a common early symptom of MS.

  • What types of headaches do people with MS experience?

    Headaches associated with MS include migraines, tension headaches, and cluster headaches. These headaches are also common in people without MS.

    Migraine headaches usually last 4 to 72 hours and include throbbing on one or both sides of the head. Migraines are also often accompanied by sensitivity to light or sound, nausea, vomiting, or loss of appetite.

    A cluster headache is an extremely painful headache that strikes quickly and feels like an electric shock or explosion in or behind the eye. Cluster headaches occur on one side of the face and tend to recur at the same time every day for weeks.

    Tension-type headaches are usually mild or moderate headaches that last anywhere from 30 minutes to several days.

  • What causes MS headaches?

    MS-related headaches are most likely caused by brain lesions. MS lesions are areas of the nervous system where the myelin sheaths covering nerves are damaged.

    Headaches can also be a side effect of MS medications, such as interferon B-1a or 1b, fingolimod, modafinil, or amantadine.