Managing headaches with MS

Does MS cause headaches?

There’s no clear evidence that MS directly causes headaches. MS activity in the brain and nervous system might have an effect, directly or indirectly. But no definite cause has been found.

Headaches can be a side effect of medication, including disease modifying therapies (DMTs) for MS.

If you get headaches, your doctor or MS team can help you manage them. 

Severe headaches can occasionally be a sign of something that needs immediate medical attention. The NHS has advice about when to call 111 or 999 for a headache.

Types of headache with MS

There are different types of headaches. Two seem to be more common for people with MS: migraine and tension headaches.

Migraines

A migraine is usually a very bad, throbbing pain on one side of the head.

Some people get other symptoms just before this, like:

• yawning a lot and feeling tired
• feeling thirsty or craving foods
• mood changes
• a stiff neck
• peeing more.

Some people have what’s called an aura, which happens just before the headache. They can last up to an hour. Migraine aura symptoms can be:

• changes in what you see, like zigzag lines or flashing lights
• numbness or tingling (pins and needles)
• feeling dizzy
• finding it hard to speak.

Tension headaches

A tension headache feels like pressure on both sides of the head or neck. Sometimes the area feels tender if its touched. Tension headaches often last at least 30 minutes. They can last much longer.

What does an MS headache feel like?

If you’ve got MS and you get headaches, you might have any of the headaches other people get, including:

• migraine
• tension headaches
• cluster headaches

These will probably be treated and managed just like other people would. 

If you have pain behind or around the eyes, that could be more closely linked to your MS – though it isn’t always. For example it could be that you need new glasses. But it might be optic neuritis. And that might be treated with a short course of steroids.

Whatever kind of headaches you’re getting, check them out with your doctor or MS team so you can find the right treatment for you.

How to manage headaches and migraines when you have MS

Your GP or MS team can help you find ways to treat and manage headaches, including migraine. So if you’re getting headaches, it’s important to let them know. Once the headache has been diagnosed, treatments are usually the same as for people who don’t have MS. That often means a combination of drug treatments and other ways to manage it.

You might be referred to a pain clinic, where a range of health professionals specialise in managing pain. 

Drug treatments for headaches

Drug treatments for headaches including migraine could include:

• nonsteroidal anti-inflammatory drugs, like ibruprofen and aspirin
• antiepileptics
• antidepressants
• beta blockers
• botulinum toxin (Botox) 

Your doctor can explain more about how these work and any side effects.

Non-drug treatments for headaches

Non-drug treatments for headaches can include CBT (cognitive-behavioural therapy) and meditation. Doctors might also look at things in your lifestyle which might make a difference. That could include looking at your diet, posture, or how active you are. 

A pain clinic might suggest trying electrical nerve stimulation devices which are held on your forehead or neck.