Is there a link between MS and increased incidence of migraine?

With numerous symptoms that challenge their lives every day, multiple sclerosis (MS) patients also appear to suffer almost twice as many migraine events as their healthy counterparts. According to a soon-to-be-published study, this represents nearly 24% of individuals with a MS diagnosis.

First, some basic facts about migraine: it’s one of the most common chronic diseases in the United States and around the world, affecting roughly 15% and 14% of the populations respectively. Migraines are thought to be the result of interactions occurring between neurons, glial cells (which are the cells that help support, connect, and protect the neurons of the central and peripheral nervous systems), vasculature or the arrangement of blood vessels, and inflammatory signaling. Symptoms may include but are not limited to:

• Recurrent, unilateral headaches that may last anywhere from a few hours to a few days.
• Nausea
• Light and noise sensitivity
• Dizziness
• Fatigue, mood changes, and other issues.

 
Read more about migraine in our previous blog at: https://www.suzannegazdamd.com/blog/migraines-the-science-causes-and-treatment-options
 
MS is a neurological autoimmune disorder that has over the last 30 years become increasingly prevalent worldwide, which may be due in part to more sophisticated diagnostic tools, socioeconomic factors, and geographic influences. We have written extensively about the disorder, its potential treatments, and much more at https://www.suzannegazdamd.com/blog---ms-in-the-news.
 
The National Multiple Sclerosis Society explains “Multiple sclerosis is a disease that impacts the brain, the spinal cord, and optic nerves, which make up the central nervous system and controls everything we do. The exact cause of MS is unknown, but we do know that something triggers the immune system to attack the CNS. The resulting damage to myelin, the protective layer insulating wire-like nerve fibers, disrupts signals to and from the brain. This interruption of communication signals causes unpredictable symptoms such as numbness, tingling, mood changes, memory problems, pain, fatigue, blindness and/or paralysis. Everyone’s experience with MS is different and these losses may be temporary or long lasting.”
 
More evidence regarding a link.
 
MS patients have a much higher risk of experiencing migraine symptoms than the general population. Additionally, migraine and MS patients share similar demographics, with the highest incidence among young, female patients with no history of another established condition.
 
Many decades ago, studies began reporting on the MS/migraine connection. In 1952, Compston described a possible association, noting that 2% of patients develop migraine within three months of the onset of MS.
 
The strongest evidence to date for an association between migraine and MS comes from a cohort study within the Nurses’ Health Study II.  A 2012 study found that women with migraines prior to their diagnosis of MS had a 39% higher risk of developing MS when compared to the participants without migraines.
 
What are the pathophysiological mechanisms between migraine and MS and MS and migraine?
 
Some of the mechanisms contributing to the link between the disorders:

1. Dysfunction of the brain circuitry modulating the peripheral nociceptive stimuli (areas of the brain networks for pain stimuli and pain suppression). 
2. Migraines may occur due to direct MS-related damage to certain brain structures or due to changes in metabolic activity. An increasing amount of evidence, much of it clinical, suggests that migraine is a response to cerebral energy deficiency or oxidative stress levels that exceed antioxidant capacity and that the attack itself helps to restore brain energy homeostasis and reduces harmful oxidative stress levels.
3. Neuroinflammation: Brain imaging studies show white matter lesions in both MS and migraine patients. Neuroinflammatory mechanisms likely play a key role in downstream effects.
4. Geography: One theory is that the headaches of MS are attributable to the geography of demyelinating lesions or where the lesions are such as the brain stem and periaqueductal gray matter. The periaqueductal gray (PAG)s implicated in multiple functions, such as pain, analgesia, fear, anxiety, and cardiovascular responses and is believed to be a central hub for the integration of the pain experience.
5. Cortical Spreading Depression (CSD): Another potential mechanism is that migraine, and specifically migraine with aura, may lead to subtle increase in permeability of the blood–brain barrier and neuroinflammation. Migraine is thought to generate from CSD and the aura phase that precedes migraine headache in about 20–30% of migraineurs may be a direct consequence of the events of CSD; the role of CSD in migraine patients without aura is not well understood and as such the relationship cannot yet be explained.

 
CSD, a slowly propagated wave of depolarization followed by suppression of brain activity, is a remarkably complex event that involves dramatic changes in neural and vascular function.
 
This electrophysiologic event underlying migraine and an attack trigger may be a crucial factor for promoting MS onset by facilitating contact between peripheral immune cells and the usually privileged CNS structures. CSD may increase factors that influence the integrity of the blood–brain barrier permeability, thereby initiating neuroinflammation.

Image credit: Huang, S.Y., Salomon, M. & Eikermann-Haerter, K. Advanced brain MRI may help understand the link between migraine and multiple sclerosis. J Headache Pain 24, 113 (2023). https://doi.org/10.1186/s10194-023-01645-7 

In summary…
 
There are many environmental factors that may lead to the onset of migraine and multiple sclerosis – clearly, more research is needed to better understand the corresponding links between these disorders.
 
As we have continually stressed in previous writings and in our clinical practice, lifestyle modifications also can be helpful not only in promoting general health and wellness, but in patients living with nearly any chronic disease. That’s why we also continue to encourage patients to be informed about your or your loved ones’ conditions and to be aware of all available resources!
 
The American Migraine Foundation has a wealth of helpful literature regarding the disorder and potentially helpful lifestyle approaches to consider:
 
https://americanmigrainefoundation.org/resource-library/lifestyle-changes-for-migraine/
 
And please visit our blog library as well for other related reading, including:
 
https://www.suzannegazdamd.com/blog/study-shows-that-dietary-intervention-could-aid-migraine-sufferers
 
https://www.suzannegazdamd.com/blog/migraine-remedies-can-a-drug-for-ms-or-natural-treatments-help
 
https://www.suzannegazdamd.com/blog/what-if-there-was-another-way-to-treat-neuropathic-pain
 
If you have questions or need to schedule a visit, please reach out to our offices – we’re here to help!
 
In hope and health,
Dr. Suzanne Gazda
 
References:
 
Mohammadi, M. et al. The association between multiple sclerosis and migraine: A meta-analysis. Multiple Sclerosis and Related Disorders. Volume 79, 2023.
https://doi.org/10.1016/j.msard.2023.104954.
https://www.sciencedirect.com/science/article/abs/pii/S2211034823004558
 
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202
 
Stovner, L.J., Hagen, K., Linde, M. et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain 23, 34 (2022). https://doi.org/10.1186/s10194-022-01402-2