Getting an accurate diagnosis for multiple sclerosis (MS) can be challenging, especially when the initial symptoms overlap with other conditions like migraine. In fact, there are significant similarities between the symptoms of MS and the symptoms of migraine.

Not only can both conditions cause vision changes, but they can also cause numbness, tingling, and other overlapping neurological symptoms. Migraine and MS also both cause lesions on your brain that can be seen with magnetic resonance imaging (MRI).

That’s why knowing the difference between the two is essential in getting an accurate diagnosis. Below, we explore the connections between MS and migraine, including why the two conditions are sometimes hard to tell apart and what health experts look for on MRI scans to differentiate between the two.

Why Are MS and Migraine Sometimes Hard To Tell Apart?

When someone has MS, their immune system mistakenly attacks their brain and spinal cord. This, in turn, causes demyelination (damage to the protective covering of the nerve fibers). Meanwhile, migraine is a neurological condition that can cause migraine attacks, sometimes accompanied by auras (visual changes) and other symptoms.

The symptoms of the two conditions can overlap, and they both can cause lesions to develop on the brain. It’s also possible to have both MS and migraine at the same time. These factors can make it challenging to tell the two apart.

Here’s what you need to know about these overlapping characteristics.

Migraine Lesions Can Be Similar to MS Lesions

People with migraine have a higher risk of developing lesions in the white matter of the brain (tissue on the inside of the brain). In some people, these lesions can sometimes show up in parts of the brain that are typically affected by MS, such as near the brain’s surface.

Because migraine can cause small white-matter spots on MRI, some people with frequent headaches can have MRI findings that look similar to MS. But that doesn’t mean they truly have MS. Doctors still need your symptoms, exam, and other tests to make an MS diagnosis.

This is one reason MS can be misdiagnosed if the MRI is viewed without the full history. A neurologist looks for an MS pattern over time and rules out other causes.

Migraine and MS Occur Together

Migraine also occurs more frequently in people with MS than in the general population. In fact, if you have MS, you have nearly twofold increased odds of having migraine compared to those without the condition.

In one study, about 47 percent of people with MS had migraine pain at least seven days each month.

Migraine and MS May Be Linked

Researchers are studying whether migraine may occur more often in people who later develop MS, or as part of the prodromal phase (the early phase of an illness or disease).

In one study, women who developed MS experienced migraine up to 10 years before they experienced typical MS symptoms. However, migraine is very common in the general population, and most people with migraine do not develop MS.

More research is needed to understand whether migraine is directly related to MS or whether the two conditions simply occur together more often than expected.

What Are the Differences Between Migraine Lesions and MS Lesions on MRI?

Because migraine and multiple sclerosis can look similar on MRI scans, it can be hard for healthcare providers to tell the difference between the two. Not only do both conditions cause white-matter lesions seen with MRI, but they’re sometimes located in similar areas.

Here are some distinct differences between the two that healthcare providers use to tell them apart.

Lesion Size and Shape

MS brain lesions tend to be bigger than migraine lesions. In fact, one team of researchers estimates that MS lesions are usually at least 3 millimeters long, while migraine-related lesions are usually smaller and average about 2.5 millimeters in size.

MS and migraine lesions also have different shapes. Migraine lesions are usually smaller and rounder with a somewhat stretched or elongated appearance. Meanwhile, MS lesions are more ovoid (egg shaped).

But lesion size and shape alone can’t diagnose MS. Doctors look at the pattern and location of lesions, plus your symptoms and other test results.

Number and Location of Lesions

The location and amount of lesions can provide hints to radiologists (doctors who analyze your imaging tests, like MRI) as to whether the brain lesions are related to MS or migraine.

When it comes to the location of the lesions, some areas of the brain can be affected by both migraine and MS. But people with MS typically have a much higher number of these lesions.

MS lesions are typically perpendicular to the ventricles of the brain and located around the corpus callosum (a bundle of nerves connecting both hemispheres of the brain). When this occurs, it is referred to as Dawson’s finger.

Researchers discovered an important feature of these brain lesions that might help differentiate between MS lesions and migraine lesions. This feature, called the “central vein sign” (CVS), appeared to be more common in MS lesions than in migraine lesions.

Doctors use CVS as one piece of the puzzle along with lesion patterns, symptoms, and other test results.

What Other Tests Can Differentiate MS and Migraine?

In addition to an MRI, which is the most noninvasive way to examine the brain and spinal cord, your neurologist may use other tests to help confirm a diagnosis of MS.

How Long Does It Take To Diagnose MS?

Diagnosing MS has traditionally been a challenge. In fact, when the condition’s diagnostic criteria were first introduced in the early 2000s, it took roughly four years to get a diagnosis.

But in 2024, the diagnostic criteria were updated. Under these guidelines, known as the McDonald Diagnostic Criteria, people are diagnosed more quickly — often within one year on average.

If you suspect that you have MS, be sure to communicate with your healthcare provider about any new or worsening symptoms, including headaches. Also, be sure to follow through with any recommended MRI or imaging appointments.

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