The information you should know about MS and headaches

MS and headaches are a frequent and painful combination that we, MSers, have to live with. While everybody gets a headache from time to time, most of them can be easily gotten rid of with an over the counter medication such as “Ibuprofen” or “Acetominophen.”

Many MSers report that the pain is excruciatingly painful. The incidence of both migraines and cluster headaches worldwide is significantly higher in MSers than most other people.

WHAT’S THE LINK BETWEEN MS AND HEADACHES?

For the average person most doctors will tell you that they really do not know what causes a good number of the headaches we get. It is different for someone with MS and headaches as they can mostly be attributed to:

• The lesions on the brain that MS causes

• The medications that MSers are taking to fight some of the other symptoms
• Sometimes caused by depression.

In a recent study of some 277 patients with multiple sclerosis it was found that there may be a direct connection between the number of lesions in the mid brain area and the number of migraine headaches that an MSer might get.

At the same time lesions in this area of the brain have been linked to cluster headaches where the trigeminal nerve originates.

Patients in the middle of an episode of Optic neuritis also report having severe headaches on one side or the other, what made it worse for me was that any movement of my eyes increased the level of pain.

Once in a while these headaches can have a direct effect on your quality of life, especially if your vision is too compromised by its effects.

Another area where MS and headaches are very common is triggered by the medications that we use as part of therapy treatments for the disease. Interferon based drugs such as Rebif, Betaseron, and Avonex are known to cause headaches or make them worse. I remember having some terrible headaches when I was using Avonex

Something that definitely help me was that I used to take a couple of “Tylenol's” (Acetominophen)every couple of hours to wear off the flu-like symptoms of the medicine. I’m sure they help me with the headaches. Although I did have quite a few of them, only a few times they were really bad.

HOW AWFUL CAN THEY BE?

When it comes to MS and headaches, is a different story each time. Sometimes (the best ones), the headaches compare quite well to regular tension headaches, which usually are:

• Bilateral
• Can be in the back of the head
• Neck region
• Temple
• Forehead (as if the head were squeezed or clamped in a vise.)

But, most often with MS and headaches the big question is just how bad these headaches can get. Once you go beyond the everyday typical headache and explore the area of migraines and cluster headaches you are going off the Richter scale of headaches. Now you are really talking serious pain:

MIGRAINE HEADACHES

MSers with relapsing remitting MS seem to have them more frequent. They can be described as:

1. Often begin with blurry or distorted vision signaling that a headache is about to begin or “prodrome symptoms” (including fatigue, hunger or anxiety)

2. Throbbing on one or both sides of the head

3. Can be accompanied by sensitivity to light or sound

Typically accompanied by nausea, vomiting or loss of appetite
4. Residual pain and discomfort often follow headaches

5. Lasting from 4 to 12 hours

1. Fatigue

2. Irritability
3. Problems concentrating
4. Dizziness.

I find the use of cold packs applied to the back of my head (base of the neck) or in the forehead helpful to cope during peak times.

If you want to watch a very informative presentation on the anatomy of migraines Click here to watch it!

CLUSTER HEADACHES

These types are common whenever there is talk about MS and headaches.

1. May begin as a severe burning or stinging sensation on one side of the nose or deep in one eye

2. Pain peaks rapidly
3. Feels like electric shocks or “explosions” in or behind the eye
4. Only on one side of the face
5. Comes on without warning (unlike many migraines)
6. Tend to recur at the same time every day (often soon after falling asleep), usually for a period of several weeks
7. Can cause eye to water, nose to run or eyelid to droop
8. Pain completely resolves after headache (until next headache)
9. Lasting from 15 minutes to 3 hours

Some studies have shown a possible link between cluster headaches and brain lesions in the area of the brain, where the trigeminal nerve, which is also called the fifth cranial nerve originates.

MSers can get Trigeminal Neuralgia, a form of facial pain. This is usually a series of brief sharp/stabbing/electric-like pain in the upper or lower jaw area. These attacks are intermittent, recur frequently, both day and night and can last for days at a time.

The pain may be initiated by stimuli applied to certain areas of the face, lips, or even gums, for example during chewing, brushing teeth, etc. Whenever this is the case, there is treatment for it and you should discuss it with your neurologist

For those of you that do not have Multiple Sclerosis (MS), for comparison purposes, here is a brief description of the most common type of headache in the general population. This headache can be described as follows:

1. Constant, band-like aching or squeezing sensation

2. Pain is either right over the eyebrows or encircling the head
3. Comes on gradually
4. Can happen any part of the day, but usually occurs in the latter part of the day
5. Lasting from 30 minutes to all day

These headaches rarely cause severe pain, more often the pain is considered to be moderate or mild. It can be dealt with many over the counter pain killers.

There are medications designed to relieve the pain associated with MS and headaches, but you should consult with your doctor to see if there are any contraindications with any medications you are already taking. If there are you may be left with doing the best you can to cope with them until the episodes have passed. For more information on headaches and migraines, an excellent site for you to visit is Headache Adviser.com

WHAT CAN YOU DO TO GET SOME RELIEF?

Depending on the type and intensity of the headache you could just need an over-the-counter analgesic like “Aspirin”, “Tylenol”, “Advil” or “Motrin”.

If you find yourself needing analgesics more and more keep in mind, when deciding which pain killer to take, that if you are using any of the over-the-counter drugs available, to avoid liver problems in the future, an “ibuprofen” based pain killer is less harmful to the liver, than “acetaminophen” based meds. It is always a good idea to talk to your doctor before taking any new medication. Let’s not forget that you have MS, so when it comes to MS and headaches, certain drugs may work better. It depends on the cause and only your doctor is qualified to determine if the headaches are being caused by any of the MS medications previously prescribed, any of your MS symptoms or something else is triggering them.

Just recently I read a post from another MSer mentioning how he uses ice bags over his head and a cooling vest to get some relief from the pain of MS and headaches he frequently gets .

I don’t know why I did not think of that tip to deal with the problems related to having MS and headaches before (having used my Steele cooling vest to fight my ms fatigue with very good results.

I guess it never occurred to me to try it until I read his post and decided to do it. Let me tell you that I have gotten rid of the past recent headaches a lot quicker than before since I started following this tip:

1. I myself prefer to take 400 mg of “Ibuprofen” on a full or semi-full stomach.

2. I usually placed a cold ice bag over my head or at the base of the head/neck while lying down and keep my eyes closed.
3. Recently began loading and wearing my Steele cooling vest to help me get rid of my headaches and it has work really well. I wish I had known this before. I have had my cooling vest for over 10 years and never thought of using it this way.

I like to thank, Jorge45 for sharing this tip on our MS forum.

For those Migraines and cluster headaches, the drugs belonging to the family of Tryptamine-based drug, are selective serotonin receptor (5-HT) agonists – “A medication that has an affinity for and stimulates the activity of cell receptors…” used in the treatment of acute migraine attacks and cluster headaches:

• Sumatriptan

• Rizatriptan
• Naratriptan
• Zolmitriptan
• Almotriptan
• Frovatriptan
• Eletriptan

SOME RECOMMENDATIONS FOR YOU TO COPE WITH MS HEADACHES:

1. TAKING NAPS Some people find that a long nap (5 or more hours) following a migraine helps relieve some of the residual symptoms.
2. KEEPING A JOURNAL Recording and taking notes on the specifics of your headaches, including time of day they started, how long they lasted, any triggers that you might have noticed and anything that you did (including medications) that helped.

   A journal as such could be very useful and will help your doctor to determine what might be causing the headaches, what type they are and what kind of treatment to try.

3. OH THOSE WONDERFUL COLD PACKS! Putting ice (with the use of a towel to avoid ice burns) is really comforting. You could use ice packs kept in the freezer for this purpose. I usually just grab a couple of the ice packs that go with my cooling vest and Viola!, fast relief.

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