Lhermitte's sign

Lhermitte's sign is an electric shock-like feeling that runs down your spine from top to bottom. You may find it continues into your arms and legs. It can be a sign of multiple sclerosis, but also happens in other conditions.

Lhermitte’s sign is a type of nerve pain that feels a bit like an electric shock. Some people describe an odd buzzing feeling. It gives you a sudden jolt on the back of your neck and runs down your spine. This sensation may move into your arms and legs and sometimes onto fingers and toes.

It usually only lasts a few seconds but can be very intense. For some people it’s painful while for others it just feels a bit strange. It is not life-threatening.  

Although Lhermitte’s sign is not exclusive to MS, it is one of its paroxysmal symptoms which come on suddenly, sometimes in a cluster, and are short-lived. Like many of these, Lhermitte's sign may come and go over time.

Pronounced “Ler-meets” after neurologist Jean Lhermitte, it's also known as Lhermitte's syndrome and barber’s chair syndrome, and you may hear its sensations described as zingers. 

In MS, Lhermitte’s sign is caused by damaged nerves in the spine responding to neck movement. It usually happens when you bend your head towards your chest for example when you have a haircut. Your damaged nerves, which are no longer fully protected by their myelin sheath, try to relay this action to your brain but it causes confusion. This can mean your brain interprets the message as pain even though there is no physical reason.

Lhermitte’s sign is common in multiple sclerosis but there are other causes. If you've not been diagnosed with MS, you should consult a health professional to investigate why you are experiencing this sensation. 

A 2013 review of past studies into the prevalence of different kinds of pain in people with MS showed that on average, 16 in every 100 had Lhermitte’s sign. This was confirmed in a study of 694 people with MS which was published in 2015. The likelihood of experiencing Lhermitte’s sign did not correspond to someone’s age, gender, level of disability – as judged by their EDSS score – or how long they had been diagnosed.

As Lhermitte’s sign is usually triggered by certain movements of the neck, you could try avoiding these whenever possible. As with many other MS symptoms, fatigue, stress and heat can also be triggers. It can help to pace yourself carefully, manage your stress levels and keep cool in hot weather.

Lhermitte’s sign can be unsettling as it appears without warning. Mindfulness can make it easier to live in the present moment, rather than wondering if Lhermitte’s sign will affect you unexpectedly. Relaxation techniques such as meditation and massage can be helpful. You can also read our information on how to manage nerve pain.

Lhermitte’s sign is rarely treated as the pain is so sharp and sudden that it does not usually last long enough for pain treatments to take effect. However, there are some treatments that may help if the symptom is particularly troublesome. Talk to your MS nurse, neurologist or GP about your options.

A soft neck brace or collar can limit how much your neck moves and minimise triggering Lhermitte’s sign.

A physiotherapist may be able to suggest ways that you can improve your overall posture to help prevent an attack. You may be taught progressive muscle relaxation techniques, deep breathing exercises or stretching exercises which can take the edge off your pain.

Electrical stimulating devices, such as TENS (transcutaneous electrical nerve stimulation), are helpful for some people.

The drug treatments for Lhermitte’s sign are the same as for other types of neuropathic pain, usually amitriptyline (Triptafen), duloxetine (Cymbalta), gabapentin (Neurontin) or pregabalin (Lyrica) in the first instance.