Migraine and multiple sclerosis: Epidemiology and approach to treatment

Migraine is a highly prevalent neurological condition that commonly affects patients with multiple sclerosis (MS). In this review, we examine the case for a clinical and epidemiological association between migraine and MS and discuss how to diagnose and treat migraine effectively in MS patients. If there is an epidemiologic association between MS and migraine, a causal relationship remains to be demonstrated and the effect-size, at best, appears to be small. Accurate diagnosis of migraine in MS patients is important for improving care by (1) distinguishing symptoms related to MS versus migraine, (2) recognizing that migraineurs have altered sensory perception, which may influence the patient experience of certain MS-related symptoms, such as paresthesias and pain, (3) informing disease modifying therapy selection and (4) optimizing migraine treatment with appropriate preventive and acute therapy.