Based on PubMed | Can multiple sclerosis cause headaches, and how can I tell if my headache is related to MS?

Headaches can occur in people with multiple sclerosis (MS), but they are usually not considered a classic MS symptom on their own. Evidence suggests headaches are more common in individuals with MS than in the general population, and they can appear at disease onset or during the course of MS. However, most headaches in people with MS resemble common primary headache disorders like migraine or tension-type headache rather than a unique “MS headache.” ^[1] Headaches have been reported in over half of MS cohorts, yet studies indicate they generally do not track reliably with MS relapses or specific clinical features. ^[2]

What the research shows

• Headache frequency appears higher in MS populations, with reports around 50% or more, including migraine and tension-type headache as the most common types. ^[3] This increased prevalence has been replicated, but whether it exceeds the general population consistently remains debated. ^[1]
• Case reports describe severe migraine-like headaches when MS lesions involve “strategic” brain regions (for example, midbrain or brainstem), suggesting demyelinating lesions can occasionally trigger secondary headaches. ^[1]
• Disease-modifying therapies (DMTs) for MS, particularly interferon beta, can induce or worsen headaches in some individuals, and this should be considered when starting or adjusting treatment. ^[4] Interferons and other MS therapies may have headache listed among common side effects and can exacerbate migraine frequency or cause new headache patterns. ^[3]

Is headache an MS symptom?

Headache is not generally categorized as a core MS symptom like visual changes, numbness, weakness, or coordination problems, but it is a frequent complaint among people living with MS. ^[1] Early clinical studies found no distinctive “MS headache” pattern, with most headaches classified as tension-type or migraine, and they did not consistently correlate with relapse activity or disease progression. ^[2] That said, certain lesion locations and medication effects can make headaches more likely in MS. ^{[1] [3]}

How to tell if your headache could be related to MS

Because most headaches in MS look like common primary headaches, distinguishing an MS-related headache from a typical migraine or tension-type headache relies on context:

• New or changing pattern: A sudden change in headache characteristics (onset, intensity, location, frequency) in someone with MS may suggest a secondary cause, including lesion-related effects or a medication side effect. ^{[1] [3]}
• Association with neurologic symptoms: Headache that occurs with new MS-type neurological signs such as double vision, imbalance, focal weakness or numbness, or vision loss could indicate a relapse or a lesion in a strategic region, and warrants prompt evaluation. ^[1]
• Timing with MS therapies: If headaches start or intensify soon after beginning or adjusting interferon beta or another DMT, the medication may be contributing. ^[4] In some cases, preventive headache treatments are considered to improve adherence to MS therapy. ^[3]
• Strategic lesion involvement: Rarely, demyelinating lesions in regions like the midbrain or brainstem can produce severe migraine-like pain; imaging and clinical correlation help clarify this. ^[1]

Red flags that need urgent medical attention

Certain headache features suggest a dangerous secondary cause and should prompt immediate medical care, regardless of MS status:

• “Worst headache of life” or abrupt thunderclap onset. ^[5]
• Headache with fever, neck stiffness, or confusion (possible infection, such as meningitis). ^[5]
• New neurological deficits (weakness, speech problems, seizures, vision changes). ^[5]
• Headache triggered by exertion and associated with vomiting or sudden change in severity. ^[5]
• Headache in pregnancy or postpartum, or with cancer, HIV, or anticoagulation. ^[5] These features point to serious conditions like hemorrhage, aneurysm, venous thrombosis, meningitis, arterial dissection, or mass effect, not typically MS-related. ^[5]

Common headache types seen in MS

• Migraine: Throbbing head pain, often one-sided, with nausea and sensitivity to light or sound; may include visual or sensory aura. Migraine is frequently reported among people with MS and may be biologically linked. ^{[6] [1]}
• Tension-type headache: Band-like, pressing pain with mild-to-moderate intensity, often related to stress or muscle tension; also commonly observed in MS cohorts. ^[2]
• Occipital neuralgia or cluster-like attacks: Less common but described in some cases, potentially tied to lesion location. ^[3]

Practical steps to figure out if your headache is related to MS

• Track patterns: Keep a simple diary noting timing, triggers, aura, associated symptoms, medication changes, and relation to MS flares. Patterns can reveal medication effects or migraine triggers. ^{[4] [3]}
• Review medications: If headaches began after starting or changing interferon beta or other DMTs, discuss dose timing adjustments, hydration, or switching therapies if severe. ^{[4] [3]}
• Assess neurologic context: If a headache accompanies new neurologic deficits suggestive of a relapse, contact your MS specialist; MRI may be needed to assess for active lesions. ^[1]
• Consider preventive therapy: For frequent or disabling headaches, preventive medications or procedures (for example, Botox for chronic migraine) can be evaluated to maintain MS therapy adherence and improve quality of life. ^[3]
• Rule out other secondary causes: Evaluate for sinus disease, blood pressure changes, sleep issues, medication overuse, dehydration, or other secondary headache causes. ^[5]

When to see your clinician

You should seek medical review if:

• Your headaches are new, worsening, or different from your usual pattern. ^[1]
• Headaches are interfering with daily life or MS treatment adherence. ^[3]
• You have red flags as listed above that suggest a secondary, potentially serious cause. ^[5]

Bottom line

• Headaches occur commonly in people with MS, but they are usually migraines or tension-type headaches rather than a distinct “MS headache.” ^[2] Headaches may be more frequent in MS, can appear at onset, and can be influenced by medication effects or lesion location in rare cases. ^{[3] [1]}
• If your headache pattern shifts, coincides with new neurological symptoms, or starts after an MS therapy change, it may be related to MS activity or treatment and deserves targeted evaluation. ^{[4] [1]}
• Pay attention to red flags and seek urgent care when severe, sudden, or neurologically complicated headaches occur. ^[5]