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MS research update – Are headaches more common during a relapse? – 9 May 2016


Headaches are more common in people with MS. This study investigated if headaches were more likely to occur during a relapse than remission.

People with relapsing remitting MS and people without a neurological condition were questioned about if they had experienced a headache in the previous seven days and if so what were the characteristics of the headache. The people with MS were questioned during a relapse and the again three months after they had recovered.

It was found that headaches were more common during a relapse, particularly migraines. However headaches were more also more common in people with MS during remission too, when compared to the general population.


Previous research has shown that headaches are more common in people with MS than the general population, as has been covered in previous research updates on headaches and migraines.

This study investigated if headaches were more common during a relapse and what type of headaches these were.

How this study was carried out

57 people with relapsing remitting MS and 57 people without a neurological condition (control group) in Iran took part and completed the study.

The people with MS were recruited to the study when they attended a hospital clinic as they were having a relapse. Members of the control group were recruited from the friends and family members that were accompanying a person with MS to the clinic.

Participants were questioned about if they experienced headaches over the previous seven days. The headaches were diagnosed and classified against the types in the International Classification of Headache Disorders.

For those that experienced headaches, information about the characteristics of their headaches were collected including:

  • what type they were (migraine, tension headache or secondary headache – that is one which is the symptom of something else such as a hangover or caused by another health condition such as a sinus or ear infection)
  • the severity of the headaches on a scale of 1 (lowest severity) to 10 (very severe)
  • the quality of the pain (compressing, pulsating or stabbing)
  • the location of the headache in the head and if this was in one location or could be felt in several locations
  • the presence of other headache symptoms, in addition to pain (aversion to light, aversion to sounds, nausea, vomiting)

For the participants with MS, the researchers also collected information about their MS, current treatment with disease modifying drugs and the characteristics of the relapse they were experiencing. These participants were followed up three months after their relapse and asked the same questions about headaches.

What was found

The study found:

  • Nearly half (45.6%) of the people with MS having a relapse also experienced a headache, compared to over a third (38.6%) of people when they were in remission and just under a third (27.7%) of people without a neurological condition experienced a headache.
  • Headaches were more common in people with MS during a relapse.
  • The most common type of headache to experience during a relapse was migraine, followed by tension headache.
  • Headaches experienced during a relapse more reported to be severe and described as compressing.
  • The most common headaches experienced during remission were also migraines but these were described as being less severe.
  • People who had been diagnosed with MS in the last three years were more likely to experience a headache during their relapse than people who had been diagnosed for longer.
  • No relationship was found between headache and the type of relapse (so site of the MS lesion).

What does it mean?

The study shows that headaches, and particularly migraines, can be more common in people with MS during a relapse. However headaches have already been found by previous research to be more common in people with MS and this is reflected in the current study by the number of people that reported headaches when they were also in remission, compared to people without neurological conditions.

However the design of this study means that although it has shown that headaches are more common during a relapse and also more likely to occur in people who have had MS for a shorter period of time it cannot explain why. The authors conclude that headache may be a warning sign that a relapse is coming and early treatment could potentially prevent a relapse developing further. However further research would be needed to investigate the link in more detail, as headaches are also highly likely to occur during remission too.

Togha M, Abbasi Khoshsirat N, Moghadasi AN, et al.
Headache in relapse and remission phases of multiple sclerosis: a case-control study.
Iran J Neurol. 2016 Jan 5;15(1):1-8.
Read the full text of this paper

More about headaches

Two previous studies covered in research update have shown that headaches and migraines are more common in people with MS than in the general population. You can read more about migrainecluster headaches and tension type headaches on the NHS Choices web site. There is also information on other causes of headache.

Headache is a known and common side effect for some of the disease modifying drugs including Copaxone and Tysabri.

Headache can be just one type pain that people with MS may experience. If you are experiencing frequent headaches or other pain you could speak to your MS specialist team or GP. They may be able to help directly or may refer you to specialist support.

You can read more about pain in MS and the treatments that can help in the A-Z of MS.

Research by topic areas...

Drugs in development

Havrdová E, Belova A, Goloborodko A, et al.
Activity of secukinumab, an anti-IL-17A antibody, on brain lesions in RRMS: results from a randomized, proof-of-concept study.
J Neurol. 2016 May 3. [Epub ahead of print]

Other treatments

Gil Sánchez A, Lacasa Andrade E, Valls Marsal J, et al.
A study to evaluate the effect of ultrasound treatment on nodules in multiple sclerosis patients.
Int J Neurosci. 2016 May 4:1-20. [Epub ahead of print]

Pregnancy and childbirth

Cox JL, Koepsell SA, Shunkwiler SM.
Therapeutic plasma exchange and pregnancy: A case report and guidelines for performing plasma exchange in a pregnant patient.
J Clin Apher. 2016 May 3. [Epub ahead of print]


Jokubaitis VG, Spelman T, Kalincik T, et al.
Predictors of long-term disability accrual in relapse-onset multiple sclerosis.
Ann Neurol. 2016 May 4. [Epub ahead of print]

Provision of care

Mynors G.
Evaluating the role of the MS specialist nurse.
Br J Nurs. 2016 Feb 11-24;25(3):136.

Psychological aspects

Roy S, Schwartz CE, Duberstein P, et al.
Synergistic effects of reserve and adaptive personality in multiple sclerosis.
J Int Neuropsychol Soc. 2016 May 6:1-8. [Epub ahead of print]

Carletto S, Borghi M, Bertino G, et al.
Treating post-traumatic stress disorder in patients with multiple sclerosis: a randomized controlled trial comparing the efficacy of eye movement desensitization and reprocessing and relaxation therapy.
Front Psychol. 2016;7:526.
Read the full text of this paper

Blair M, Gill S, Gutmanis I, et al.
The mediating role of processing speed in the relationship between depressive symptoms and cognitive function in multiple sclerosis.
J Clin Exp Neuropsychol. 2016 May 4:1-13. [Epub ahead of print]


Campbell E, Coulter EH, Mattison PG, et al.
Physiotherapy rehabilitation for people with progressive multiple sclerosis: a systematic review.
Arch Phys Med Rehabil. 2016 Jan;97(1):141-51.e3.
Read the full text of this paper

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