Migraine in Multiple Sclerosis: Underlying Mechanisms, Shared Symptoms, and Approaches to Management

Background: Migraine affects approximately 50% of people with relapsing-remitting multiple sclerosis (MS). People with MS and migraine also have greater symptom burden and an increased risk of relapse. Understanding the pathophysiology, symptoms, and approaches to migraine treatment is critical to improving outcomes for this population. Methods: A narrative review was conducted to investigate the pathobiological mechanisms of comorbid migraine in MS, the impact of psychological and cognitive symptoms, and the available treatment options. Results: The review identified potential reciprocal mechanisms in comorbid migraine and MS, including recurring MS-related inflammation, brainstem lesions, neuroinflammation in migraine, and the disruption of the blood-brain barrier. Shared demographic and endocrine risk factors for MS and migraine were detailed, along with the effect of MS treatments on worsening preexisting migraine. Both disorders were associated with subjective and objective cognitive deficits, particularly affecting processing speed, attention, and executive functions, as well as higher rates of depression and anxiety compared with the general population. In MS, preventive migraine treatments were underprescribed. Selection of prophylactics should include consideration of comorbid symptoms, such as depression and fatigue. Evidence also supports the potential efficacy of behavioral interventions for migraine prevention. Conclusions: While much remains to be understood, recognizing the comorbid symptoms and appropriate migraine treatments for people with relapsing-remitting MS can guide clinical decision-making and promote quality of life. Further research is needed to evaluate the efficacy of such therapies for people with MS.