28 msfocusmagazine.org Do headaches cause MS, does MS cause headaches, or is there another link (or none at all)? These are questions that clinicians and researchers interested in the intersection between headache and MS are trying to answer, but they are also questions that many people with MS face on a regular basis. A recent article by German researchers and neurologists in Brain and Behavior reinvigorated the debate by reporting that 78 percent of 50 patients seen for early MS had a recent headache at the time of evaluation. The relatively small number of people with early MS and clinically isolated syndrome in this study, the unclear lag from first MS symptom to onset of headache, and the lack of information on each person’s prior headache history, raise questions about whether this study can be used to argue that headaches are an early MS symptom or not. Why does it matter if headache is an MS symptom? It isn’t purely an academic exercise of whether MS causes headaches (after all, MS can cause lots of different symptoms). But if headaches can be counted as an initial (and later) MS symptom, then there are a number of important consequences: 1. People who are currently labeled as having radiologically isolated syndrome (people who have MRIs that look like MS, but experience no symptoms) who have a certain type of headache, could then be diagnosed as MS or clinically isolated syndrome. 2. MS disease-modifying therapies may be offered to people earlier.An overwhelming amount of data has shown that while treating MS later is good, treating it as early as possible is even better. 3. If someone with MS has a certain type of headache then this could be interpreted as breakthrough disease activity, which could have implications for switching MS DMTs. Is there an MS-specific headache? It remains unclear whether headache is a symptom of MS – it appears that for some people, headaches can be an MS symptom. The problem is that it is hard to know whether an individual headache is an MS symptom for an individual person with MS. It did appear that a lot of the people in the studyhadheadachesthathadmigrainefeatures. Migraines are common (approximately 40 million Americans have migraines), while more than 99 percent of the U.S. population has “ever had a headache.” MS, while not common, is also not rare – research presented Symptom Management MS and Headaches by Daniel Kantor, M.D.