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Managing Headaches in MS

Managing MS

May 26, 2023

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Photography by Alba Vitta/Stocksy United

Photography by Alba Vitta/Stocksy United

by Jenna Fletcher


Medically Reviewed by:

Susan W. Lee, DO


by Jenna Fletcher


Medically Reviewed by:

Susan W. Lee, DO


MS headaches may be related to medications, lifestyle, environmental triggers, or other factors. Most are manageable with a few simple approaches.

Multiple sclerosis (MS) can cause a wide range of symptoms and does not affect everyone in the same way. However, for many people with MS, headaches are common.

In fact, a small study suggests people with MS who are in a relapse may experience more headaches than people without MS. Researchers are not yet certain why this may be. What is known is that headaches have a variety of causes, so it’s important to consider both MS-related factors as well as other causes.

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How are MS and headaches related?

Pain is a very common complaint among people living with MS. Increasingly, researchers are finding that headache — not previously considered a typical symptom of MS — may in fact be a very common source of pain for people who live with the disease.

A 2021 systematic review of studies found that about 56% of people with MS experience primary headaches — those that occur independently, without an underlying medical cause. Migraine, cluster, and tension headaches are all types of primary headaches.

One very small study looked at 50 people who were newly diagnosed with either MS or clinically isolated syndrome. It found that as many as 78% of those people had headaches within the 4 weeks prior to the study, suggesting that headache may be an early warning sign of MS.

Because of the limited nature of the study, more research into this is needed. It’s also important to note that people can also have MS headaches later in the disease course.

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What types of headaches do people with MS get?

People living with MS can experience all three major types of primary headache. These include:

  • migraine
  • cluster
  • tension


Migraine is one of the most commonly reported headache types associated with MS. While prevalence varies from 2–67% across continents, the prevalence was highest in American and African countries (43% for both) with an estimated average worldwide prevalence of about 31%.

Migraine episodes typically present on one side of your head and cause a throbbing or pulsating headache. They often occur in the morning upon waking and may occur at predictable times, such as during a stressful time or during menstruation.

Following the headache, you may feel exhausted or tired, but after a few hours or days, you’ll typically feel fully recovered.

This type of headache often affects women more than men.


Cluster headaches often come on suddenly and cause severe pain on one side of your head, often behind one eye, for about 5 to 10 minutes. Once it has peaked, you may continue to feel pain for a few hours.

They get the name “cluster” because they often come in clusters, occurring at the same time each day or night for several weeks at a time. Another defining characteristic is that they’re accompanied by one autonomic symptom, like bloodshot or watering eyes, swollen eyelids, forehead or facial sweating, runny or congested nose, or even a sense of agitation or restlessness.

Unlike migraine, cluster headaches occur more frequently in men than women. They also occur more frequently in people who smoke.


Tension headaches occur due to emotional or stressful situations that lead to tightening muscles in the jaw, neck, face, and scalp. Other causes can include habitual jaw clenching, depression, missing meals, and other triggers.

Pain with tension headaches often occurs on both sides of the head. The pain may go away when the stress or underlying cause goes away, but it may also linger beyond the period of stress.

What causes MS headaches?

Researchers don’t yet know if the disease process or some other factor causes such a high prevalence of headaches among people living with MS.

In the general population, an inflamed or irritated trigeminal nerve is often responsible for headaches.

In a 2020 review of studies, researchers noted that several known symptoms of MS affect this and other nerves commonly involved in headaches. These symptoms include:

  • Optic neuritis: A visual problem caused by damage or inflammation to the optic nerve.
  • Trigeminal and occipital neuralgia: Pain in the face or the bottom of the head, respectively, caused by damage or inflammation to these two nerves in the head.
  • Lhermitte’s sign: A sensation of electrical shock that extends down your spine with neck movement, caused by dysfunction in the spinal cord.

As a result, they theorize that MS headaches may occur as a result of these conditions.

The researchers also noted that headaches and MS share some other similar characteristics. For example, both:

  • occur more in women than men
  • have a relapsing-remitting form (where symptoms get worse or flare and then get better)
  • have environmental and genetic risk factors

Other theories suggest that the location of MS lesions in the brain may be responsible, as midbrain lesions are commonly associated with headache. Additionally, the demyelination that occurs with inflammation (for example, during a flare) may cause headaches to spread to other regions of the brain.

Another possible culprit is cortical spreading depression (CSD), a condition in which suppressed electrical and chemical activity spreads across the brain and is then followed by a wave of increased activity. This can activate pain in the trigeminal region and is also widely believed to be responsible for the experience of auras that occur before migraine episodes.

CSD, in turn, may lead to an increased ability for T-cells to cross the blood-brain barrier, causing further demyelination and potentially more headaches.

Future research may be helpful in determining a more precise relationship between MS and headaches.

Medication side effects

Certain disease-modifying therapies (DMTs) for MS — specifically, those that use interferon beta, can cause headaches.

If this appears to be true for you, you and your neurologist may be able to identify a different DMT that won’t produce headaches as a side effect.

Lifestyle and environmental triggers

Environmental factors can trigger headaches in anyone, whether they live with MS or not. You may find it helpful to be aware of some of the most common triggers, and try to avoid them. These include:

  • strong odors or smells
  • sudden changes in weather
  • exposure to bright light
  • loud noises
  • hormonal changes
  • caffeine
  • not eating enough or going too long between meals
  • dehydration
  • stress
  • lack of exercise
  • poor sleep quality
  • drinking alcohol
  • smoking
  • overexertion during exercise or activities

Keep in mind that headache triggers vary from person to person, so figuring out what might bring on your headaches can play an important role in how you treat headaches with MS.

Other underlying health issues

Several underlying health conditions, apart from MS, can contribute to or worsen headaches. If you have or experience any of the following, it may help explain some of your headache pain:

  • depression
  • anxiety
  • reaction to certain medications
  • sleep disorders
  • motion sickness
  • head trauma
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How to prevent and treat MS headaches

If you have frequent or regular MS headaches, determining your triggers may help you avoid them in the future. For this reason, it may be helpful to keep a journal where you can record important information about each headache, like:

  • when your headache started and ended
  • where the pain is located
  • the severity of the pain
  • the type of pain — sharp, dull, throbbing, etc
  • what your sleep was like the night before
  • what you ate and drank that day
  • what you were doing when the headache started
  • what the weather was like
  • any other known triggers

Armed with this info, you can begin to make lifestyle adjustments that may be helpful. You can also bring this information to your next doctor’s appointment and discuss any possible changes to your medication or other aspects of your treatment plan.

In the meantime, you can try over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help manage headache pain in the short term.

However, if your headache persists or you find yourself reaching for these treatments frequently, contact your physician. Using these medications frequently (more than 2 days a week) can lead to medication overuse headaches, in addition to other adverse health outcomes.

MS may make it more likely that you will have headaches, but the exact relationship between MS and headaches is still a mystery. Headache may be an early symptom of MS, though more research is needed in this area.

The takeaway

People with MS often report migraine, cluster, or tension headaches. Many people will find relief by identifying and avoiding triggers, getting enough sleep, eating a healthy diet, exercising regularly, and managing stress.

Some MS medications can also cause headaches, so it’s important to discuss your MS headaches with your doctor to ensure you get the best treatment.

Medically reviewed on May 26, 2023

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About the author

Jenna Fletcher

Jenna Fletcher is a freelance writer and content creator. She writes extensively about health and wellness. As a mother of one stillborn twin, she has a personal interest in writing about overcoming grief and postpartum depression and anxiety, and reducing the stigma surrounding child loss and mental healthcare. She holds a bachelor’s degree from Muhlenberg College.

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