Background and purpose: Headache is one of the pain syndromes in multiple sclerosis (MS). Migraine is one of most frequent types of headache among patients with MS. The aim of this study was to investigate the association between MS and migraines.

Materials and methods: A cross-sectional study was conducted in 60 patients with definite MS. The brain MRI scans were obtained and the location of lesions and number of lesions and locations were recorded and compared.

Results: The study population included 51 females and 9 males. Among the patients 82% were diagnosed with remitting-relapsing MS and 18% had secondary progressive MS. Patients with headache were found with higher number of lesion locations compared with those without headache (P= 0.0001). Compared with MS patients without migraines, migraineurs with MS had larger sizes of lesions in midbrain, cerebellum, thalamus, frontal and temporal  lobes (P<0.05) while migraine patients with aura had more significant involvement of the frontal lobe and less significant involvement of the occipital lobe than migraine patients without aura (P= 0.035 and P= 0.011, respectively). Same results were found for number of lesions in MS patients with and without headache. The difference in number of lesions in subjects with and without aura were observed only in occipital lobe. (P= 0.031).

Conclusion: The presence of MS plaques in the infratentorial region mainly midbrain and cerebellum and supratentorial region especially the frontal and temporal lobes, and thalamus may contribute to the increase in occurrence of headache with migraine characteristics.