Pain, including headache, is a common symptom in patients with MS. Prevalence of headache in patients with MS has been reported to be higher than 50%.¹ One study² found that among 204 MS patients the relative frequency of migraine was three times higher than in the general population. The same study also found that, on brain MRI, migraine status was not significantly associated with disability or T2 lesion burden. However, the MS–migraine group was more symptomatic than the MS–no headache group.

Case reports show that isolated MS lesions in regions such as the midbrain may cause severe headaches similar to migraine; however, migraine may also be a comorbid condition of MS.¹ The adverse effect profile of some MS disease-modifying agents includes headache, and treatment with these agents may trigger migraines and other types of headache in susceptible patients. Thorough evaluation of headache in patients with MS is essential to optimizing patient management and helping to improve quality of life. Treatment protocols for headache in patients with MS are generally the same as those for the general population, and referral to a headache specialist may be warranted in patients whose symptoms interfere with activities of daily living or remain uncontrolled with routine treatment.

1. Putzki N, Katsarava Z. Headache in multiple sclerosis. Curr Pain Headache Rep. 2010;14:316-320.
2. Kister I, Caminero AB, Monteith TS, et al. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain. 2010;11:417-425. Epub 2010 Jul 13.