Here is another great question (and, hopefully, answer) from Neurologique's open Facebook page.
Why do some MS people feel so unfocused in the head and what can be done to help this feeling?
There are many potential reasons for this:
1. Related to medication side effects.
2. From the MS itself -- fatigue.
3. From the MS itself -- cognitive problems.
4. Something also called "MS brain fog"
6. Not from MS, but something else.
In terms of how to approach treatment, it is going to depend on the cause. Non-pharmacologically we use meditation (especially mindful meditation), breathing exercises, visual imagery, acupuncture, yoga, tai chi, cooling, etc.
Pharmacologically, we maximize the MS disease modifying drugs and we choose appropriate symptomatic treatments, like medicines for fatigue (Amantidine, Provigil, Nuvigil, B12, Caffeine, Stimulants etc.). At Neurologique we are also looking at an Ayurvedic herb called Ashwagandha for MS -elated fatigue.
Interestingly, there are two medications that I call "NeuroFunctional Enhancers" because they enhance function in people with neurological diagnoses. Thus far the class is made up of:
1) Ampyra (dalfampridine) -- FDA approved for gait dysfunction in MS, but because it helps the nerves work better, it can help in lots of ways.
2) Nuedexta (dextromethorphan + quinidine) -- FDA approved for pseudobulbar affect (regardless of cause), which is, basically, problems with coordinating your emotions and how you display them to others (affect). It has an effect on blocking the effects of glutamate in the brain, and is an NMDA antagonist and Sigma-1 Agonist (scientific mumble jumble)
I hope that this was useful.