Exploring the Connection Between Multiple Sclerosis and Migraines: Unraveling the Intricate Link

Multiple Sclerosis though it’s been over seven decades since researchers first noted a possible connection between multiple sclerosis (MS) and migraine, the precise nature of the relationship between the two conditions remains a bit enigmatic. And with good reason. While MS is characterized by overactive immune activity that targets the central nervous system (CNS) and migraine attacks are thought to arise in those with CNS sensitivity, a recent study found that most people with both migraine and MS—like everybody else—don’t have the headache disorder as a result of MS-related damage. In fact, the study of people with MS found that 79% of those who reported having had headaches of any type on a regular basis (most of them migraine) reported that the headaches actually predated their MS diagnosis.
Still, “migraines are not causing multiple sclerosis,” says Justin Abbatemarco, M.D., a staff neurologist at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research in Cleveland, OH. “And I don’t think the inverse is true, even though we do know it’s a common comorbidity.”
Yet at least 31% of people with MS have migraine, estimates a 2012 study in Multiple Sclerosis and Related Disorders, compared with just 15% of the overall population worldwide. In other words, there’s some kind of link between migraine and MS—though not a direct one. Still, by understanding some of the ways they may share common ground, you can better manage them both.

How Are Migraine and MS Connected?

Both migraine and MS are shaped by changes in the central nervous system, which is composed of the brain and spinal cord and controls the body’s ability to take in and respond to all sensory input.
An individual with migraine is generally believed to be dealing with a more sensitive nervous system. Migraine may likely be “triggered” by an unusually large number of suspects—ranging from inside and outside the body—yet, whichever of these somehow leads to a state in which some signal achieves activation of the trigeminovascular system, a vast web of nerves conducting pain sensation throughout much of the face and head. Associative links with structural changes in the brainstem of particular migraine types prior to and during attack also suggest that the pain-processing role of this region of the brain is crucial for understanding the disorder.
There are no clear causes of multiple sclerosis but, we do know that MS is an autoimmune condition that involves the CNS. It´s features immune cells mistakenly attacking myelin, the protective coating around CNS structures called axons . Axons, electric messengers between body parts. And like migraines, MS also associates with damage to the brainstem, home to one of the highest concentration of CNS structures.

Sharing Some Features

Though classically distinct neurological conditions with entirely different implications, MS and migraine do share a few parallels.

Risk Factors

When it comes to your odds of developing either condition, age and gender play a similar role. “Migraine is going to be much more common in our younger populations, the teenage years, 20s, and 30s—which is the same time that we’re developing MS,” says Dr. Abbatemarco. Both conditions are also more common in women, who develop migraine at roughly twice the rate of men and MS at three times the rate of men. In both cases, it’s likely related to hormonal factors. There may also be overlap in genetic risk factors: One recent study published in Neurology linked four specific genetic variants to both migraine and MS.

Brain Imaging

For example, brain MRIs studies of individuals with MS frequently contain characteristic white spots in central nervous system (CNS)-associated areas with corresponding patterns that can reflect both inflammation and equally indicative and analyzable demyelination, the stripping of axons’ protective myelin sheath. And chronic migraine, with its recurring jumble of neurological symptoms, can cunningly mimic exactly these MRI configuration patterns, sometimes leading to an initial false MS diagnosis.
Nevertheless, most neurologists say the chance of migraine being mistaken for multiple sclerosis or vice versa is pretty slim. “It is true that migraine can be associated with changes in the brain,” says David Duncan, M.D., medical director of the Comprehensive MS Center at the Hackensack Meridian Neuroscience Institute of Jersey Shore University Medical Center in Neptune, NJ. “Those can usually be differentiated by a trained neurologist or neuroradiologist from the white spots you see in the brain with MS. They’re generally in different locations, and they’re different shapes and sizes.”
Still, it turns out that more people with migraine are being diagnosed with MS, even when doctors have better ways to tell the two apart.

Vision Changes

Both MS and migraine can affect vision. At its simplest, both can cause problems such as double or blurred vision and changes to color perception.
In migraine, about 25 percent to 30 percent of people encounter auras, a series of disorienting sensory changes that can precede or accompany the signature headache, according to The American Migraine Foundation. Although auras can include auditory symptoms like ringing in the ears, they are most often visual. As a result, they may look like outlines filled in with fuzzy spots, flashing lights, zigzags, or blind spots, noted the foundation.

Painful Episodes

In MS, a condition known as optic neuritis, or inflammation of the optic nerve, can also cause auras. Visual symptoms from optic neuritis often signify the initial onset of MS, which is why someone having vision changes is often sent for an immediate MRI of the brain. Painful Episodes
While multiple sclerosis (MS) and migraine are different diseases, both are chronic (long term) with recurring symptoms rather than “attacks.” In MS, these intermittent episodes are called exacerbations, or often, flares or relapses. They can last from 24 hours to several months, during which time old symptoms may reappear and/or worsen and new ones can emerge. Because MS can affect almost every sensory and motor aspect of the body’s functioning based on where the lesions are, these exacerbations can vary tremendously from person to person or even episode to episode.
Similarly, migraine attacks often occur at irregular intervals, although the characteristic headache’s duration tends to fall within different time frames from those of MS flare symptoms — 4 to 72 hours.
Though the specific symptoms of migraine attacks and MS flares don’t overlap, there are a number of shared triggers for both, including:
changes in the weather (especially heat)sudden hormonal fluctuations (like those during pregnancy)changes in medicationstress
One thing that MS and migraine have in common is their tendency to change over time, she said. “The symptoms can look very similar from one MS flare to another, but in general it’s a neurodegenerative disease, and what’s happening is that people are getting more and more brain damage over time,” White said. Over time, worsening symptoms — even if at a slow pace — result from that ongoing damage, she added. “This is the nature of the disease; in late stages — after many decades of having the disease — most people, at least two-thirds of all those with MS, will go on to something called secondary progressive multiple sclerosis, at which point they don’t really have attacks anymore — the symptoms are just always there, always getting worse.”
Chronic migraine doesn’t mean the person is stuck on a trajectory of increasingly severe attacks. While for some people migraine gets worse over time, for others the attacks become less frequent or less painful as they age. In addition, although migraines can cause small lesions or other structural changes in the brain, these do not necessarily affect function and may not worsen over time.
According to Dr. Abbatemarco, while the percentage of people affected by the condition of migraine is “one of the most common neurological diseases out in the world,” at 15%, multiple sclerosis affects about only about 0.4% of the world—but that number is on the rise, research shows.

Treatments for Multiple Sclerosis

Your doctor will aim to slow the progression of the disease, manage symptoms, and improve your quality of life by recommending treatments tailored to your specific needs. Some options.

Disease-Modifying Therapies (DMTs)

These drugs adjust or suppress the immune response that is primed to attack the CNS. The armamentarium for MS has grown dramatically in the last few years, and numerous therapies now in use can delay serious nerve damage and related cognitive decline. “The hard part now isn’t telling people ‘We don’t have any drugs.’ The hard part now is deciding which drugs are best for that patient,” says Dr. Duncan. One last thing to keep in mind: some DMTs can exacerbate priorre-existing headaches or cause a headache as a side effect, so make sure to have a thorough discussion with your doc if you have a history of migraine.

Symptomatic Treatments

There are a variety of medications and therapies used to specifically manage a symptom of MS — such as nerve pain, fatigue, muscle spasms, bladder problems, and many more. These may also include as-needed treatments that can help ease the burden of flare-ups when they do occur. A high dose of corticosteroids is often an important short-term treatment to manage symptoms in a severe flare.
Syndicated from Contently

Physical and occupational therapy

The motor difficulties that might eventuate as MS progresses often make physical therapy, which can assist with changes in coordination, balance, strength, and more, a helpful tool. Occupational therapy can do the same for changes in daily living with cognitive or other functional changes.

Lifestyle changes

Preventing and predicting flare-ups and worsening symptoms, if it’s your MS trigger, may be as simple as indulging a love of healthy habits like a balanced diet, regular and adequate sleep and exercise, and avoidance of things like tobacco, alcohol, and stress.

Migraine treatments

Medications for migraine fall into two broad categories; acute medications to ease an oncoming or in-progress attack, and preventative drugs for those with the chronic form of the condition that are designed to lessen the likelihood of attacks.

Acute Treatments

There are a few different medications commonly used to make migraine attacks less painful and incapacitating. These include:
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, which can help you get rid of pain quickly.
Triptans, a class of drugs that mimic the neurotransmitter serotonin in the brain that’s been proven to relieve headaches from migraine.
Antiemetics, another drug class of drugs specifically anti-nausea medications that includes (as over-the-counter varieties) Dramamine and Benadryl. Because many of these medications are over-the-counter, people with chronic migraine may overuse them, and this can be dangerous; they’re ideally taken tailored to an individual’s needs under the guidance of a doctor.

Preventative Treatments

A recent study suggested that while nearly 40 percent of chronic migraine sufferers who sought out preventative treatments saw the number of their migraine episodes reduced by more than 50 percent. A number of drugs can help decrease the frequency of migraines when taken daily, this can be reduced with a few that includes the following:

• Antidepressants
• Anti-seizure medications
• Blood pressure medications

Moreover, there are a slew of second-lines treatments, each with varied efficacy. In some cases, tiny amounts of botulinum toxin — Botox — injected into the muscles can provide relief by relaxing the involved nerves and blocking pain signals.
Magnesium sulfate is a mineral that you can inject directly into your veins. It’s also a treatment of known efficacy for acute episodes of eclampsia, according to the 19th edition of the medical guidebook Medical Knowledge Self-Assessment Program (MKSAP).

While the mineral has been used for centuries and non-invasively for migraines for years, there is a growing body of research to support the contention that magnesium sulfate administered intravenously is an acute treatment for migraines of known efficacy — particularly in people who experience auras.

Key Takeaways

While multiple sclerosis and migraine aren’t conditions to which the phrase “hurt so good” is typically applied, they nonetheless combine in more than a few individuals, and their impact on the body — especially in the brain — has some surprising crossover. For example, when it comes to headache triggers, some MS medications may “induce” or exacerbate them. In light of that, such treatment might not be a “first migraine medication choice” for someone already plagued by a migraine history. If you’re such an individual, counsel your doctor regarding potential side effects of your treatment plans for each affliction. It’s also possible to get by with a little help from your friends — and your doctor. By “addressing not just your multiple sclerosis and headache, but also your overall health,” for instance, the National MS Society points out, a “holistic” approach to treatment can help provide the kind of support needed to more effectively manage the demands of a life in which both MS and migraine have roles.