Multiple Sclerosis (MS) is one of the most common neurological disorders affecting the brain and spinal cord. Some of the symptoms in the early stages are similar to migraine attacks, leading to diagnosing challenges and suggesting a potential connection between MS and migraines.

Some research shows people with MS experience more headaches, including migraines, compared to the general population. Around 30%  of people with MS report experiencing migraine, while the percentage for the general population is about half that. There is a higher prevalence of migraine and MS in American and African countries and a lower prevalence in Asian and European countries.

So far, studies have yet to show a clear connection. Are headaches symptoms of MS, or are they simply co-morbid with the neurological condition? 

Migraines and Multiple Sclerosis

Migraines and MS have different causes but share some symptoms. 

In multiple sclerosis, your immune system attacks the myelin sheath, a protective coating around your nerves. Possibly, inflammation exposes myelin to T-cells, which are the "attack cells" of your immune response. The exposure could lead to the demyelinating lesions found in MS.

No apparent cause for migraine is identified, although it may be a chemical or hormonal issue. 

Migraines and MS share the following symptoms:

• Vision problems
• Pain 
• Tingling 
• Weakness 

However, migraine tends to cause nausea, which is not typically present in MS. Also, the visual issues differ between the two conditions.

MS can cause an individual to suffer optical neuritis, swelling of the optic nerve not seen in migraines. Optical neuritis can result in double vision, the loss of color vision in one eye, or the loss of vision in one eye. 

Migraine visual issues, especially migraine with aura, tend to include:

• Bright flashing lights
• Sparkles
• Spots 
• Zigzag lines

Most people with MS and migraines reported headaches before their MS diagnosis. At the same time, other MS patients never had migraines before the first MS symptoms occurred. Sometimes, people don't learn they have multiple sclerosis until a bad headache leads to brain imaging tests. 

Are MS and Migraines Linked?

Researchers have not found definitive links between MS and migraines, but there are several commonalities between the two conditions.

Both are chronic conditions consisting of attacks followed by a period of remission. Around 85% of MS patients have relapsing-remitting MS. Migraines are also episodic. 

An attack of neurological symptoms and disability in MS is known as a relapse, followed by a cessation of symptoms called remission. Migraineurs also suffer symptoms that fade and remain in abeyance for a period.

However, the duration of symptoms between conditions is very different. MS symptoms can last weeks, while migraines are limited to hours or days.

MS, like migraines, can be episodic in nature. Symptoms come and go, causing an MS flare. During a flare, headaches are more likely and painful, especially migraines with aura.

Emotional issues like anxiety and stress can lead to MS flares and trigger migraines, and brainstem damage can cause migraines. Since the brainstem is where nerve injury from MS often appears, it is not unexpected for migraines to occur in the same patient.

People with MS have differing levels of disability and rates of disease progression, and migraineurs have unique triggers and symptoms associated with their attacks.

Misdiagnosis 

Because MS and migraines share similar symptoms and patterns of relapse and remission, it is possible for an individual to be misdiagnosed with MS instead of migraine and vice versa. 

Both conditions can show brain abnormalities on an MRI, such as brain lesions called white matter lesions or T2 hyperintensities. However, the pattern of abnormalities is different. A doctor should carefully interpret the lesions on the MRI and consider the individual patient’s symptoms before making a determination.

The most frequent alternate diagnosis for people who were told they had MS is migraine. Some patients believe they have MS for years before learning they suffer from migraines. Such misdiagnoses cause stress and expose patients to unnecessary treatments.

The potential for misdiagnosis makes it critical for patients to report the duration and quality of their symptoms to their healthcare provider, along with details of frequency and intensity.

Treatment and Prevention

If you have MS and migraines, tell your physician. Sometimes doctors become so focused on your MS symptoms that they neglect to ask about migraine or headaches. Your doctor can help you determine if your migraines are related to your MS medication, brainstem damage, or an MS flare. 

You may need a change in treatment if your current medication worsens your migraines. On the other hand, migraines might signal an MS flare is imminent, allowing you to take a flare preventative before one can occur.

You stop or reduce migraine pain by:

• Taking a migraine preventative or abortive
• Obtaining counseling for stress and fatigue that may trigger migraines or MS flares
• Avoiding common migraine triggers, like chocolate, salty foods, aged cheese, and alcohol

Patients receiving Interferon Beta Therapy sometimes experience an increased risk of headache, usually within a few days of the injection but not at other times. Topiramate is a migraine preventative that can cause cognitive symptoms that resemble MS.

Both conditions respond well to lifestyle changes.

Summary

Multiple sclerosis and migraines share many symptoms, but there is little evidence of a direct link between the two conditions. However, people with MS are more likely than the general population to suffer migraines. Some MS medications can also trigger migraines.

Misdiagnosing migraines for MS can cause stress and reduce the quality of life, so obtaining a correct diagnosis is critical for appropriate care. 

If you suffer from migraines, keep a migraine diary and record the frequency, duration, and intensity of your head pain and what you ate before the attack. A diary can help your doctor correctly diagnose your condition and provide proper treatment.