Headaches are common, but for individuals with Multiple Sclerosis (MS), migraines often have unique characteristics. People with MS experience headaches, including migraines, more frequently than the general population. While the exact link between MS and headaches is still being studied, the presence of headaches is recognized as a notable symptom within the MS experience. Understanding these headaches can help individuals with MS better manage their condition.
Characteristics of MS-Related Headaches
MS-related headaches, particularly migraines, often present as moderate to severe throbbing or pulsating pain, aggravated by movement. This pain typically lasts between 4 and 72 hours. It is frequently unilateral, but can also be bilateral or concentrated in areas like behind the eyes, or in the head and neck.
Beyond the head pain, MS-related migraines often include associated symptoms like auras. Auras are reversible neurological symptoms that precede or accompany the headache. Common visual auras include bright zigzag lines, flashing lights, spots, or wavy lines, lasting approximately 20-45 minutes. Less commonly, auras might involve sensory symptoms like tingling or numbness, motor weakness, or speech difficulties.
Sensitivity to light (photophobia) and sensitivity to sound (phonophobia) are frequently reported alongside nausea and sometimes vomiting. Other symptoms that can accompany these headaches include dizziness, general fatigue, and a sensation often described as cognitive fog, where thinking feels less clear. These symptoms can vary widely among individuals with MS.
How MS Headaches Differ
MS-related headaches often present with unique characteristics that distinguish them from general migraines or other headache types. The presence of MS can influence headache characteristics, leading to unusual symptom presentations or a different response to standard migraine treatments. For instance, migraines with aura have shown a strong correlation with MS exacerbations, suggesting they might serve as a marker for flare-up onset.
Visual symptoms in MS-related headaches, particularly those with aura, are primarily characterized by “positive” visual phenomena, meaning things appearing in vision, rather than vision loss. This contrasts with visual problems in an MS relapse, which are more likely to involve double vision, blurry vision in one eye, or loss of color vision. Additionally, migraine auras are generally short-lasting and tend to follow a similar pattern, unlike the more prolonged visual symptoms of an MS flare.
Headaches in MS might sometimes be mistaken for other neurological symptoms of the disease. For example, pain behind the eye mimicking migraine symptoms could be caused by optic neuritis, a condition that can occur with an MS relapse. While numbness and tingling can be symptoms of both migraine aura and MS, sensory changes in migraine aura are typically intermittent and of short duration, unlike some MS symptoms.
Factors Influencing MS Headache Experience
Several elements can contribute to or worsen MS-related headaches. Disease activity, such as new lesions or inflammation in the brain and spinal cord, may trigger headaches. For example, lesions near the trigeminal nerve can cause facial pain, which may be experienced as a tension headache. Inflammation of the dura, the membrane between the brain and skull, might also increase migraine frequency.
Medication side effects are another factor, as some disease-modifying therapies (DMTs) used to treat MS can either worsen pre-existing headaches or induce new ones. Certain DMTs have been associated with an increased incidence of headaches. Beyond disease activity and medication, lifestyle factors and the emotional impact of living with a chronic illness can also play a role.
Common headache triggers like stress and fatigue may be heightened for individuals with MS. Other triggers include bright lights, loud noises, menstruation, and certain foods, particularly those high in sodium. Temperature sensitivity, such as Uhthoff’s phenomenon (where symptoms worsen with heat), can also modify the headache experience.
Seeking Medical Guidance
Consult a healthcare professional promptly when experiencing new or worsening headaches, especially with MS. Accurate diagnosis and appropriate management are necessary given the complexities of MS and its potential influence on headache presentation. Report any changes in headache patterns, such as increased frequency or severity, or headaches accompanied by new neurological symptoms.
Emergency medical care is necessary for a sudden, severe headache, especially if described as the “worst headache of your life.” Seek immediate care if accompanied by confusion, difficulty understanding speech, fainting, high fever, numbness, weakness, or paralysis on one side of the body. Other concerning symptoms include a stiff neck, trouble seeing or speaking, difficulty walking, or severe nausea and vomiting not clearly linked to other common illnesses. If headaches become more regular or stronger, or interfere with daily activities, seeking medical attention can help determine the cause and adjust treatment.