An Overview of Headaches in MS

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Some research suggests that people with multiple sclerosis (MS) are more prone to migraines and other headache disorders, like tension headaches or cluster headaches, than the general population. One study found that 78 percent of participants with newly-diagnosed MS reported having headaches in the past month.﻿﻿

Headache Types in MS
Verywell / JR Bee

Headache Types

There are three types of primary headache disorders that have been evaluated as being potentially linked to multiple sclerosis: migraines, cluster headaches, and tension headaches.﻿﻿

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


Migraines are common in people with relapsing-remitting MS.﻿﻿ They last between four and 72 hours and have some of the following features:

  • Preceded by prodrome symptoms (including fatigue, hunger, or anxiety) or an aura (blurry or distorted vision signaling that a headache is about to begin)
  • Throbbing 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 a long nap following a migraine helps relieve some residual symptoms.

Cluster Headaches

Cluster headaches begin as a severe throbbing, piercing, or burning sensation on one side of the nose or deep in one eye. They can last only 15 minutes or as long as three hours.

Characteristically, the pain:

  • Peaks rapidly
  • Occurs only on one side of the face
  • Comes on without warning (unlike many migraines)
  • Can cause eyes to water, nose to run, or eyelids to droop
  • Completely resolves (until the next cluster headache)

Tension Headaches

Tension headaches are the most common type of headache in the general population. Their duration can be 30 minutes to all day (or even up to one week).

Tension-type headaches also:

  • Rarely cause severe pain; it's most often moderate or mild
  • Come on gradually
  • Can happen during any part of the day, but typically occur in the latter part of the day


Migraine headaches can be incredibly painful, and the accompanying light and sound sensitivity can lead to people withdrawing to a quiet, dark space for hours at a time. Even when the migraine episode has passed, people are often left with residual symptoms—called the postdrome phase—which includes fatigue, irritability, problems concentrating, and dizziness.﻿﻿

Cluster headaches are often described by people as the worst pain they could ever imagine, akin to a burning ice pick being plunged into their eye. The pain from cluster headaches causes many people to fall on the floor, pull at their hair, rock back and forth, scream, and weep.

Although the pain from cluster headaches resolves and has no lingering effect like with migraines, people often feel completely exhausted after each headache.

Just as disabling as the headaches are the fear and dread that people feel knowing there is a good chance that another one is coming within hours or the next day. This anxiety can interfere with daily activities or social contact, as well as lead to insomnia.


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

MS lesions

Some research in people with MS suggests an association between MS lesions in the brain and an increase in the number of migraines and/or tension-type headaches.﻿﻿ In addition, there are reports of a headache or a migraine being the main symptom of a person undergoing an acute MS relapse.

Cluster headaches have been linked to MS lesions in the brainstem, especially in the part where the trigeminal nerve originates.﻿﻿ This is the nerve involved with trigeminal neuralgia—one of the most painful MS symptoms.

However, other studies suggest there is no link between MS and either migraines or tension headaches. One case-control study in Norway involving over 1,750 participants found that there was no increased risk of migraines or tension headaches in people with MS compared to the general population.﻿﻿

MS Medications

The interferon-based disease-modifying therapies (Rebif, Betaseron, Avonex) can cause headaches or make pre-existing headaches worse. Gilenya, another MS disease-modifying medication, may cause headaches. So can Provigil, Symmetrel, and other drugs used to treat MS-associated fatigue.


Headaches are also common during episodes of optic neuritis. These headaches are usually only on one side and worsen when the affected eye is moved.

Depression, a common MS symptom, has also been associated with headaches. Depression and migraine headaches are both linked to low serotonin levels.

When to See Your Doctor

You should see your doctor for any type of an unusual headache, a headache that keeps recurring, or one that lasts for a long time.


When evaluating your headache, your doctor will first likely ask you several specific questions about your headache in order to narrow down the diagnosis. These questions include:

  • Location: Where is the pain located?
  • Character: How would you describe your headache? (e.g. throbbing, aching, burning, or sharp)
  • Severity: What is your pain on a scale of 1 to 10, with 10 being the worst pain of your life? Would you describe your headache as mild, moderate, or severe? Is this the worst headache of your life?
  • Exacerbating or alleviating factors: What makes the pain better or worse?
  • Radiation: Does the pain radiate?
  • Onset: Was the onset of your head pain rapid or gradual?
  • Duration: How long has the pain been going on for? Is the pain constant or intermittent?
  • Associations: Are there other symptoms associated with your headache? (e.g. nausea, vomiting, visual changes)

In addition, your healthcare provider will make note of your personal and family medical history, any medications you are taking, and your social habits (e.g. caffeine intake, alcohol use, smoking).

In the case of an extremely severe headache that comes on suddenly and has not occurred previously, brain imaging tests may be done to rule out a tumor or stroke.


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

Commonly prescribed options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve (naproxen) and Advil or Motrin (ibuprofen), are usually the first-line defense in treating tension headaches and migraines.
  • Antidepressants known as serotonin norepinephrine reuptake inhibitors (SNRI), including Effexor (venlafaxine). 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.
  • 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.
  • High-dose steroids can cause headaches in some, but 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.

A Word From Verywell

It's helpful to keep a symptom log where you record the specifics of your headaches, including time of day they started, how long they lasted, any triggers that you might have noticed, and anything that you did (including taking medications) that helped. This will help your doctor to determine what might be causing the headaches, what type they are, and what kind of treatment to try.

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