The Migraine and Multiple Sclerosis Connection

Multiple sclerosis (MS), one of the most common neurological disorders, affects your brain and spinal cord. In its early stages, the symptoms of MS may be similar to or confused with a migraine attack. In addition, there are some studies that question a potential connection between MS and migraines.

How MS and Migraine Are Considered to Be Alike

MS and migraine have some similarities, including:

• They're both chronic and consist of attacks followed by periods of remission. The majority of patients with multiple sclerosis have a form of the disease called relapsing-remitting MS, which means their disease is characterized by episodes of neurological symptoms and/or disability, known as relapses. And, of course, many with migraines also experience them off and on for extended durations. However, the duration of the neurological symptoms is quite different between these two conditions, lasting from four to 72 in migraine patients and a couple of weeks, on average, with an MS relapse.
• They can involve visual symptoms. Certain MS symptoms, for example, optic neuritis, can sometimes be difficult to distinguish from those of a migraine attack, especially migraine with aura, in which visual symptoms commonly occur. Fortunately, the duration of the visual symptoms (which is shorter in patients with migraine) as well as their characteristics (visual aura usually causes positive phenomena, such as bright flashing lights; a patient with optic neuritis tends to experience decreased/blurry vision with pain during eye movement) help differentiate both conditions.
• They both have triggers that can contribute to attacks. Like those with migraine, people with MS often report triggers for their relapses or attacks, especially stress.
• They affect individuals differently. While people with MS have different levels of disability and rates of progression of their disease, migraineurs often describe unique triggers and symptoms associated with their attacks. In other words, the experience of either issue varies greatly from person to person.

The Problem of Misdiagnosis

Studies have found that migraines occur two to three times more often in people with MS than in the general population. In addition, some symptoms of migraine and MS can be similar, reinforcing the importance of reporting the duration and quality of your symptoms to your healthcare provider in detail.

Due to these potential similarities, a person having migraines may be misdiagnosed with MS. A 2016 study performed at four academic MS centers looked at records of 110 patients who had been misdiagnosed with MS, some believing they had MS for 20 years or more. The most frequent alternate/correct diagnosis was migraine, either alone or in combination with other diagnoses, which was found in 22 percent of the misdiagnosed patients.

Not only are there overlapping symptoms between the two, but both migraine and MS can show abnormalities in your brain as well. When you see a neurologist for your headaches, you'll typically have magnetic resonance imaging (MRI) of your brain. If you have migraine or MS, it may show brain lesions called white matter lesions or T2 hyperintensities, although the pattern is usually different in each. This is why these lesions need to be interpreted carefully on an MRI and considered along with your symptoms.

Of course, misdiagnosing MS (or vice versa) can be quite anxiety-provoking for a patient, as well as lead to exposure to unnecessary treatments. Scientists are working on techniques to make imaging tests more specific in hopes that fewer cases of misdiagnosis will occur in the future.

The Link Between MS and Migraine

There does appear to be a connection between MS and migraine, although the relationship has not been fully teased out. At the very least, migraine seems to often co-occur with MS. There are a variety of theories about why this link exists, but here's a look at some of the most common ones.

Migraine as a Symptom of MS

Some experts hypothesize that migraine may be an early symptom of MS, though there isn't much evidence to support this theory.

A 2012 study found that women with migraines prior to their diagnosis of MS had a 39 percent higher risk of developing MS when compared to the participants without migraines.

Keep in mind, though, the study also showed that the actual chance of developing MS over a 15-year follow-up of the women was 0.47 percent for women with migraines and 0.32 percent for women without migraines. This means that, regardless of whether or not you have migraines, your chance of developing MS is still extremely small (less than 1 percent).

Underlying Mechanisms

It's possible that there are some shared underlying mechanisms between the two conditions as well, though there's little proof to go on.

For instance, research suggests that migraine may be more prevalent in patients with MS because inflammation in the brain that occurs during migraine attacks may expose the myelin (the protective covering around your nerve fibers) to T cells, the "attack" cells, in MS. This could lead to the development of MS-associated demyelinating lesions in the brain.

Another theory suggests that a change in serotonin levels in the brain from migraine attacks could predispose individuals to MS. Again, there is still no scientific evidence that this indeed occurs.

A Word From Verywell

In the end, further studies are needed to both confirm the link between MS and migraines and to provide data as to exactly why an association exists. And remember that the chance of developing MS is still very small, regardless of your migraine background. Keep on being proactive in your health care and be candid when discussing your concerns or points of confusion with your healthcare provider.