Treatment of MS-Related Headaches

For most cases of MS-related headaches, the treatment is the same as it would be in people without MS. However, it is important to see your neurologist or the physician that is treating your MS, as certain drugs may work better to treat your headaches, depending on the cause.

It is also possible that some of the medications that you are currently taking for your MS or MS symptoms could be causing the headaches, in which case the doctor may want to alter how you take them, change to another drug or have ideas on how to cope with this side effect. Also, there are some drugs used to treat headaches that have side effects that can make MS symptoms feel worse.

Nonsteroidal Anti-Inflammatory Agents (NSAIDs)

NSAIDs, such as naproxen (Aleve), acetaminophen (Tylenol) and ibuprofen (Advil or Motrin) may help most cases.

Antidepressants

Some people may require treatment with antidepressants, as depression (a very common MS symptom) has also been associated with headaches in people with MS. Depression and migraine headaches are both linked to low serotonin levels. Antidepressants which may be effective in both MS-related depression and headaches include:

• Tricyclic Antidepressants: This is an older class of drug, and is usually not used as a first-line treatment against depression or headaches in people with MS, as these drugs tend to have side effects that can make other MS symptoms feel worse, by causing drowsiness, or difficulty passing urine. This class includes amitriptyline (Elavil), nortriptyline (Pamelor) and protriptyline (Vivactil).
• Selective Serotonin Reuptake Inhibitors (SSRIs): This include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).
• Norepinephrine Reuptake Inhibitors (NRIs):Also known as noradrenaline reuptake inhibitors (NARIs), this is a newer class of antidepressants, which includes venlafaxine (Effexor) and duloxetine hydrochloride (Cymbalta).

Migraine-Specific Agents

Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Related medications include rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax).

Steroids?

The exception to the above information about treatment of MS-related headaches is when a lesion can be seen on an MRI that is associated with the headaches or when a person is having a bout of optic neuritis. In these cases, a course of Solu-Medrol has been shown to be very effective in resolving the symptoms.

_Sources:

Gentile S, Ferrero M, Vaula G, Rainero I, Pinessi L. Cluster headache attacks and multiple sclerosis. J Headache Pain. 2007 Sep;8(4):245-7.

Pöllmann W, Feneberg W. Current management of pain associated with multiple sclerosis. CNS Drugs. 2008;22(4):291-324.