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Fibromyalgia: Bad; Fibromyalgia with Migraine: Really Bad

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Reprinted with the kind permission of Cort Johnson

There’s something about migraines and fibromyalgia and chronic fatigue syndrome (ME/CFS). Migraines aren’t usually talked about as major comorbid disorders with these diseases, but recent studies suggest that migraine may be one of the most, if not the most, common comorbid disorder for both of these illnesses.  These studies – most of them fairly small – have suggested that from 20-30% of people with FM and as many of 80% of people with chronic fatigue syndrome may experience migraines.

One study suggested that most people with ME/CFS, FM and/or GWI (Gulf War Illness) who experience tension headaches (dull head pain, pressure around the forehead, tenderness around the forehead and scalp) also experience migraines. Frequent tension headaches alone can induce an overall hypersensitivity to pain.

Perhaps because it was picked up by the medical community before “central sensitization disorders” like FM, IBS, interstitial cystitis and ME/CFS became known, migraine is not often included in that pack.  Migraine, though, appears to share similar central nervous system findings with other central sensitization disorders, and it’s hard to think of a disorder in which hypersensitivity to outside stimuli plays a bigger factor – at least for a time – than migraine.

Migraine shares some other features with ME/CFS and FM; it largely strikes women, it most often appears during times of hormonal fluctuations, pregnancy often reduces symptoms, it can be triggered in many ways, including stress, and there’s a genetic and sometimes a relapsing/remitting component. People with ME/CFS and/or migraines typically retreat to the same environment – dark rooms – in order to recover.

It turns out that migraine sufferers don’t spontaneously recover from them.  In the days or week following a migraine, many people with migraine can look very much like ME/CFS/FM patients.

One description of a typical “failed” migraine patient is instructive:

“…a middle-aged woman with chronic migraine and medication overuse, as well as fibromyalgia. In addition, there is anxiety and depression, fatigue and insomnia, and the familiar exhaustive list of psychotropics and antiepileptic drugs tried and failed.”

Now a very large study tells us definitively not only how common migraine is in fibromyalgia but also what kind of burden it adds to the illness. It turns out that the burden is large indeed.

This study also demonstrates how effective patient registries can be.  In this REDCAP study, emails sent out to 4,421 FM patients in a Mayo Clinic Patient Registry asked for demographic and medical information and included a validated “ID-migraine screener.”

The migraine screener simply asked if the participants’ headaches were associated with sensitivity to light, nausea and what kind of effect their headaches had on activity. A yes answer to two of the three questions indicated they met the criteria for migraine.

The diseases asked about included hypertension, coronary artery disease, myocardial infarction, mitral valve prolapse, epilepsy, stroke, asthma, irritable bowel syndrome, gastrointestinal disorder, glaucoma, Raynaud’s phenomenon, chronic fatigue syndrome, depression, anxiety disorder, bipolar disorder, and post-traumatic stress disorder.

(Studies suggest that having fibromyalgia is associated with an increased risk of having many other disorders including irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, sleep disorders, hypertension, type 2 diabetes, depression, and anxiety.)


1,730 people returned the questionnaire.  The demographics were familiar. Ninety-two percent of the participants were female, 97% were white, and the mean age was 56.

Some general findings stood out as well. Very high rates of depression, anxiety, chronic fatigue syndrome, irritable bowel syndrome and high rates of hypertension (something that’s probably at odds with ME/CFS), asthma and gastrointestinal disorders were found.

Migraines Very Common in Fibromyalgia

Fifty-six percent of the respondents met the criteria for migraines. (A higher percentage of FM patients met the criteria for migraines than had been diagnosed with ME/CFS.)

The “penalty” for having both fibromyalgia and migraine was a steep one. Women with FM and migraines had significantly higher chances of also having been diagnosed with hypertension (p<.004), asthma (p<.01), irritable bowel syndrome (p<.02), depression (p<.0002), anxiety ( p<.001), PTSD (p<.005), and finally (and most of all), chronic fatigue syndrome (p<.0001).

Two disorders in particular stood out:  the greatly increased risk people with FM who also experience migraines have of being diagnosed with ME/CFS and/or depression. (Many doctors’ tendency to first misdiagnose FM and ME/CFS patients with a mood disorder could exaggerate the incidence of mood disorders). That suggests, of course, a common pathophysiology is present.

Common Pathophysiology?

The authors proposed it’s past time to take a deeper look at the commonalities in FM and migraine and suggested a raft of possible factors that might fit:  alterations in neuroendocrine functioning, vascular (blood vessel) changes, immune activation, neuronal plasticity, nerve issues, hormonal influences (gender imbalance) and neurochemical alterations.

They’re not the first. Baraniuk, an ME/CFS, GWI and FM researcher, finds similar kinds of altered brain structure and “brain energetics” in all these diseases.

“Similar patterns of gray and white matter abnormalities and altered brain energetics in GWI, CFS, FM, and migraine suggest that common central mechanisms may contribute to the type of headaches and cognitive impairments perceived as ‘brain fog’.

In fact, Baraniuk proposes that the hypoxic and anaerobic conditions that migraines and other disorders which feature cortical spreading depression (CSD) leave in their wake has become chronic in ME/CFS.  In other words, whether you experience migraines or not, Baraniuk believes your brain looks like you just had one.

Migraine Treatments

Migraine is not easy to treat, but Baraniuk believes that migraine treatments can be helpful in both ME/CFS patients experiencing and not experiencing migraines and highlighted Imitrex  (sumatriptan).  Other (triptan) drugs include rizatriptan (Maxalt), naratriptan (Amerge, Naramig), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert, Almogran), frovatriptan (Frova, Migard, Frovamig), and avitriptan (BMS-180,048).

Sumatriptan is a well-known anti-migraine drug that reduces inflammation in arteries and veins in the brain by enhancing 5-HT (serotonin) production. Increased 5-HT production causes over-dilated veins to constrict. Sumatriptan also deceases the activity of nerves called the trigeminal nerves that are associated with cluster headaches.

Dr. Katherine Downing-Orr features nimodipine, a calcium channel blocker used for migraine relief, in her treatment protocol for ME/CFS. Dr. Jay Goldstein also recommended nimodipine.

Dr. Teitelbaum uses natural remedies including magnesium to get patients out of a migraine. Dr. Hyman also recommends magnesium and other factors (including CoQ10) depending on how the migraine is triggered.

Check out more possibilities for treating migraine including natural alternatives  – Migraines, Chronic Fatigue Syndrome and Fibromyalgia: Treatment Options

Poor Funding

One last commonality between ME/CFS, FM, migraine and other central sensitization disorders exists: poor funding. Despite the fact that approximately 20 million Americans suffer from migraine and that migraines cost the American economy about $30 billion a year, migraines receive just $21 million a year in funding.  Per patient/ per year spending on migraine is about the same as it is for fibromyalgia – about a dollar a year.

About the Author: ProHealth is pleased to share information from Cort Johnson.  Cort has had ME/CFS for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising.

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One thought on “Fibromyalgia: Bad; Fibromyalgia with Migraine: Really Bad”

  1. Schnitzel says:

    I had ME/CFS and fibro before my migraines started. I was prescribed Topomax for the migraines and in addition to helping with the migraines, it took away almost all of my fibro pain! I did NOT expect that. But the migraines are still much worse than the fibro ever was…

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