Headaches aren’t a hallmark symptom of myasthenia gravis (MG). However, some people with the condition say head pain is even more bothersome than other symptoms. Headaches are common in people with myasthenia gravis, often related to physical activity.

“I am getting very tired of having headaches after doing anything for 15 minutes,” one MGteam member said. Another replied, “I get headaches with my MG and usually notice them when I have been pushing to do more and not resting enough.”

Researchers believe headaches may be an important nonmotor symptom of MG (a symptom not related to movement). Keep reading to learn more about the connection between headaches and myasthenia gravis.

How Myasthenia Gravis and Headaches May Be Connected

Myasthenia gravis is known for causing muscle weakness, but many people with the disease also have headaches or migraine attacks. There are several reasons myasthenia gravis may be linked to head pain.

Eye Problems

Most people with myasthenia gravis have eye symptoms, such as:

• Ptosis (drooping eyelids)
• Dry eyes
• Eye muscle weakness
• Diplopia (double vision)

One MG subtype, called ocular myasthenia gravis, affects only the eye muscles.

Conditions related to myasthenia gravis may also cause or worsen headaches.

Eye problems are one of the most common causes of headaches in people with myasthenia gravis. When your eyes have to work harder to focus, it can lead to tension headaches or migraine symptoms.

Neck Muscle Strain

Weakness in the head, neck, and jaw muscles is considered a bulbar symptom of myasthenia gravis. About 15 percent of people with myasthenia gravis first notice bulbar symptoms.

Weak neck muscles can limit your range of motion and lead to stiffness and strain, which can trigger a headache. Headaches linked to neck stiffness are often called tension headaches.

“Still recovering from my flare-up,” one MGteam member said. “Today I have weak neck muscles and a bad headache.”

If you have weak neck muscles, you may also develop a complication called dropped head syndrome. This happens when the head falls forward because weak neck muscles can’t support it properly. Also called head drop, this condition can trigger headaches.

Fatigue and Sleep Issues

Symptoms of myasthenia gravis can make it hard to sleep, which may lead to tension-type headaches or trigger migraine. One small study found that 89 percent of people with myasthenia gravis had trouble sleeping. Causes may include medication side effects, pain, muscle cramps, or other symptoms.

Poor sleep can also lead to fatigue the next day, affecting quality of life. Fatigue is a common headache trigger both in people with myasthenia gravis and in the general population.

How Other Conditions May Contribute to Headaches

Some people with myasthenia gravis also have other conditions, called comorbidities. Some of these conditions can cause or worsen headaches. Conditions that may occur alongside myasthenia gravis include:

• Lupus — About 20 percent of people with lupus, an autoimmune disease, have headaches.
• Diabetes — Headaches can be a symptom of diabetes, often linked to nerve damage or changes in blood sugar levels.
• Autoimmune thyroiditis — Headaches are common in Hashimoto’s thyroiditis, the most common type of autoimmune thyroiditis.
• High blood pressure — Some people with high blood pressure have headaches.
• Rheumatoid arthritis (RA) — People with RA affecting the spine may have headaches, and people with RA are more likely to experience migraine than those without RA.

Some medications used to treat myasthenia gravis or other conditions may also cause headaches. “Can’t shake a headache,” one MGteam member said. “I think some of my issues are actually from some of my medications.”

For example, headache is a common side effect of methotrexate. The U.S. Food and Drug Administration (FDA) has approved methotrexate to treat RA, and doctors sometimes prescribe it off-label for lupus. Metformin, a medication used to treat diabetes, can also cause headaches.

Eye problems are one of the most common causes of headaches in people with myasthenia gravis.

Headaches may also occur with some MG medications, such as rozanolixizumab (Rystiggo) and efgartigimod alfa-fcab (Vyvgart). Talk with your doctor about possible side effects of your MG medications.

When Headaches Are a Warning Sign

In some cases, headaches may be a warning sign of a more serious problem. Morning headaches along with the symptoms below could point to a myasthenic crisis, a life-threatening complication of MG:

• Shortness of breath or trouble breathing
• Trouble swallowing
• Coughing when eating or drinking
• Difficulty clearing phlegm or saliva
• Changes in speech
• Trouble holding up your head
• Severe fatigue

About 1 in 5 people with myasthenia gravis have a myasthenic crisis at least once. A myasthenic crisis is a medical emergency and could affect life expectancy. Call 911 to get immediate treatment if you or someone else may be having a myasthenic crisis.

You should tell your neurology team or another healthcare provider about any new, worsening, or frequent headaches. They can help identify possible causes and recommend treatment options.

How To Manage Headaches With Myasthenia Gravis

Managing migraine and myasthenia gravis at the same time can feel like a balancing act. Tracking your symptoms and treatments over time may help you spot patterns and triggers. Ask your healthcare providers which information is most helpful for you to track.

For example, you may benefit from monitoring your:

• Medications
• Sleep habits
• Headache symptoms
• Food and drink intake
• Common headache locations

Tracking possible headache triggers may help you reduce how often headaches happen. For instance, if sleep problems often lead to headaches, talk with a sleep specialist about MG-friendly ways to improve sleep and manage insomnia.

If neck strain seems to cause your headaches, physical therapy may help. Your neurologist may be able to refer you to a physical therapist who has experience treating people with myasthenia gravis.

If eye symptoms seem to worsen your headaches, talk with an eye specialist. They may suggest ways to reduce eye strain and improve symptoms.

Headache Medications

Ask your doctor which headache medications may be right for you. Nonsteroidal anti-inflammatory drugs (NSAIDs) can sometimes help ease headache pain. Although they’re usually considered safe for people with myasthenia gravis, NSAIDs may interact with some MG drugs.

Some common treatments for headaches and migraine may worsen MG symptoms. For instance, magnesium supplements are sometimes used for migraine relief, but magnesium can increase muscle weakness in people with myasthenia gravis.

Always check with your neurology team before trying headache treatments, including prescription medications, over-the-counter drugs, and supplements.

Dietary Strategies

Healthy daily habits, including balanced meals, may support both headache management and MG symptom control. Ask your MG specialist about which foods to eat and which to avoid.

For example, cheese and other dairy products can trigger headaches in some people. Some people taking certain MG drugs may also be advised to avoid dairy products because of digestive side effects.

If you’re unsure which foods are best for you, ask your doctor for a referral to a registered dietitian.

Join the Conversation

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