Treating Headaches & Muscle Spasms in Fibromyalgia

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By Dr. Richard L. Bruno

At least once a week I get a sharp pain on one side of my head, sometimes
the left, most often on the right. I sometimes I wake up with a headache, but
also get one at the end of the day when I am tired. My neck also hurts on the
side where my head hurts and I often feel nauseated. One doctor says I have fibromyalgia. Another says migraines. But I don’t have flashes in front of my eyes and I don’t throw up. Is my headache a migraine?
Is it due to fibromyalgia?

Probably neither. Patients tell me they have migraine headaches because
there is pain on one side of the head plus nausea. But despite nausea, most
people with headaches don’t have migraines. Headaches are most often the
result of muscle spasms in the neck, upper back and shoulder muscles. When a
muscle on one side of the neck goes into spasm it causes not only a one-sided
headache but also pushes on the vagus nerve in the neck — the nerve that
makes the stomach “turn on” — and causes nausea.

Such single-sided headaches sound like migraines, but aren’t. What’s more,
we see many people with headaches, back and neck pain who are diagnosed
with fibromyalgia but whose pain is actually due to muscle spasms.

What causes muscle spasms? Spasms are triggered by physical and
emotional stress. Physical stress can be doing too much and becoming
fatigued or having “painful” posture. Painful posture is sitting or standing
with your back looking like a C: your head falling forward, upper back
curled over, shoulders elevated, being bent forward at the waist or tilting to one side (by the way, sitting at the computer may be the #1 cause of
painful posture.) Emotional stress can be anything from the slings and
arrows of living in the 21st century to the hard-driving, pressured,
overachieving, work-till-you-drop Type A lifestyles that many CFS/ME patients

How do you treat headaches and other muscle spasm pain? First you need to
make sure that the pain is indeed caused by a spasm. A morning headache can
be a symptom of a sleep disorder like sleep apnea. A daytime headache can be a sign of high blood pressure or hypoglycemia. Having a breakfast with 16 grams of protein and an 8 gram protein snack at 10:00 am and 3:00 pm can significantly decrease spasms and pain.

If spasms are causing pain you need to take the stress off yourself and your
muscles. You need to slow down, pace activities and rest during the day, even
lie down to take the load off your muscle for 15-minute rest breaks, one in
the morning and one in the afternoon. You also need to balance your body —
front to back and side to side, while sitting, standing and walking — so
that muscles don’t have to fight gravity to keep you upright.

A physical therapist (PT) with lots of experience treating chronic pain can help you turn off long-standing spasms. PTs can teach proper posture and suggest assistive devices to balance your body while standing and walking. Using a lumbar cushion while sitting, and a contoured, fiber-filled cervical pillow while sleeping on your back, insure good posture and turn off back and neck spasms day and night. Since heat is usually more helpful for spasms than is ice, PTs can do ultrasound (the deep heating of muscle using sound waves) and you can warm your muscles at home by taking a hot bath or shower and by using a heating pad.

Actually, you always need to keep your painful muscles warm, especially those
in your neck and shoulders, since cold also triggers muscle spasms. The
change of seasons — especially the transition from summer to fall — is very
troublesome for those with spasms since your body isn’t sure just what the
temperature is. Dress in layers and bring along a sweater to keep your
cold-sensitive muscles warm wherever you are, inside or out.

And be careful if you go to a physical therapist. Too many PTs use the “shake
and bake” method: gentle massage after your muscles have been heated by a hot
pack. Although massage and heat can relax muscle spasms and make you feel
better for a few hours, if you don’t take the stress off your muscles and
change your posture all day long the spasms and pain will return.

Once your spasms start to relax a home stretching program is indispensable.
With help from your PT you can find a few stretches for the specific muscles
in spasm. Stretch just before bed, first thing in the morning, every half
hour during the day and whenever you feel muscles tightening. A handful of
stretches combined with reduced physical and emotional stress, proper posture
and staying warm will keep muscles relaxed day and night and stop muscle
spasm pain, including those nasty headaches.

About the author: Dr. Richard Bruno is Director of Fatigue Management Programs and The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Understanding and Treating “Post-Polio Syndrome” and Chronic Fatigue, is published by Warner Books.) E-mail questions to Dr. Bruno at

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11 thoughts on “Treating Headaches & Muscle Spasms in Fibromyalgia”

  1. GlassGoddess says:

    I have never been diagnosed with Fibromyalgia, my sister was years ago. Speaking with my doctor about it recently, I simply got that many docs in the area, rheumetologists, still do believe the disease exists.

    OK- this article fits me to a T. I was diagnosed as having migraines in 2000. One of the better neurologists in town did the diagnosis. A few years later, I came to believe it was not migraine but muscle tension that starts in my left shoulder.

    I just spent the past 3 days with the most painful spasms occurring on the left side of my head.

    Here is how it applies to me though, and I wonder if anyone can explain as my docs cannot. This happens almost once a month and is absolutely connected with when my monthly cyle occurs. I have no idea what to do for this. I do some PT stretches and it will not subside. Tylenol, Advil, Excedrin Tension do not help this. Vicodin has not touched the pain….It hurts more to lay down.

    Can anyone give me info on this or what it is they do for the spasms?


    1. GlassGoddess says:

      So, no cheek pain here. Yes my eyes kill me and yes they will sometimes water. You would swear it was bad sinus condition if it was painful pressing above or under the eyes, but it isn’t. Never heard of a sinus migraine….I think “migraine” is an overused word.
      This is absolutely muscle and I know as I tried getting some screws out of sheetrock on a ceiling last night. Took a lot of effort. This morning, I could feel a tinge of the muscle spasm in my head…’s muscle.
      I have JUST been diagnosed as peri menopause at age 53. This has been going on since I was 37. Someone once told me I was having menopause headaches, but I get estrogen tests and there was no signs of menopause until very recently.
      I use heat too. I put my head on a heating pad and sometimes get those therma wraps, but it never gets rid of it. Hot water in the shower helps the most.
      I am going to look into fibromyalgia and see what I find out. I do take a .25 Xanax for a week prior to my cycle, I am regular as clockwork, and that helped a lot for a while. Not so much anymore. I was told to seek massage therapy, but I simply cannot afford it. I even dated a massage therapist/chiropractor for a while and was hoping to get treatments then. No such luck….in fact, I think he actually made it worse. Massage helps but doesn’t last with me. My muscles stay in a tensed state. The first massage I had was for 30 minutes and the masseuse told me he needed at least another hour to get all the tension out. Again, I couldn’t afford it. So……
      Thanks for the reply

    2. rem99 says:

      GlassGoddess, Except for the migraine diagnosis you have described MY symptoms to a T! About 1.5 yr ago I started having headaches w/ my periods. Sometimes they come just before or just after, but usually during. I spoke to my doctor about tehm 6 months ago and neither of us thought they were migraines. She prescribed Fioricet for me. Since then the severity has worsened and the one I had yesterday has been the worst so far. It started like a sudden tension headache, but they usually come on gradually. I thought it might be a migraine this time because of the pulsing on the left side of my head and nasua, but now I think the pulsing was a muscle spasm and the nasua may have been because of the pain (or as the article suggests, something to do with the nerve connections). I could not tolerate laying down but just sat in my darkened bedroom trying not to move. Today there is a dull pain, no spasm, but my neck and shoulder are in worse knots than usual and my head (or the muscle in my head) is actually sore to the touch. I took a muscle relaxer (old prescription for an injury) today and it gave me some relief but with dopey/drugged side effects. I don’t know that I’d recommend it (I’m sure doctors don’t recommend pulling old stuff out of the medicine cabinet!), but I would consider taking it during the next spasm headache if I haven’t seen my doctor yet. It was the worst headache I have ever had.

    3. bluerocket says:

      I have fibromyalgia and suffer from headaches. Stretching and chiropractors bring temporary relief but the problem according to Dr Paul St Amand is that Fibro is a kidney problem that can be treated. The spasms are caused by too much Phosphate/calcium being stuffed into ligaments, muscle etc because the kidneys are not removing phosphates from the body. His book is on Amazon.
      I’ve been a patient for 2 years and finally I’m back to hiking.
      Anyway I’m not a doctor but hope this helps, if it’s a placebo it’s a good one.

    4. samuel12 says:

      I get the same thing once a month and can’t figure it out. The muscle spasm is on my left side and goes into a terrible headache that anti-inflamatories or pain pills don’t touch. Does anyone else have this problem?

    5. appleton78 says:

      I too have headaches just as you described. I was however diagnosed with fibromyalgia. These headaches correspond with my menstrual cycle…they start with spasms in my upper back (next to the scapula) and the knots go right up along the spine into my neck….then the headache begins. Nothing touches this pain. Vicodin, Tramadol, Ibuprofen, etc..

      I am disabled by my fibromyalgia and these headaches. I wish someone could find something that would truly relieve the pain.

    6. Djmaplegrove says:

      I appreciate this article relating neck and shoulder spasms and nausea to the vagus nerve. I spent 10 years with chronic nausea and no doctor told be it could be from my neck, and it am disabled from chronic back pain! Finally I went to a massage therapist, and the nausea subsided. Now I know when I get nauseous, I need a massage. I can’t believe how naive some Doctors are to this and don’t relate it to the vagus nerve.
      Thank you for your article. I wish I could get some sort of relief other than paying for massages!
      Thanks again, Diane j.

    7. DarkPhoenix00 says:

      Auto accident Oct 18, 2013. Seat belt (waist strap) damaged lumbar spine (spine fusion 5/15/15 via spine access through front abdomen as well as via left and right sides of spine from back) and cervical spine (fusion surgery via front of neck access to spine Dec 23, 2016). Whiplash removed (permanently) natural curve in neck. Fibro since along with muscle spasms neck down, chronic tension & migraine headaches, moderate blockage sleep apnea (since neck redesign landed narrowed airway), permanent nerve damage in back from spasms. At moment, fighting off tension headache from turning to migraine since out of migraine script (Fioricet) until 12/29/17; this winter and past fall have been really rough on me.
      Have noticed more of the give and take connection with nature (esp elements) has been more physically taxing this year than any prior and seemingly progressively worsening as time goes by. Neck fusion, if not correcting my neck condition (weight of head causing neck spine to lean forwards….aka wrong posture), then he said he would have to come back in back of neck and fuse 4 sections in back of cervical spine (frontal fusion was just between C5 & C6). My fibro has progressed to point of being unmanageable by means from prior rheumatologist with medications, he told me as we both cried my last apptmt with him he recently read an article where only 30% of fibro cases 8n US are treated successfully, he sent me to (chronic) pain mgmt, pulled me out of work field (been working since 1996) this passed May and apologized in tears for not being able to help more.
      Trying to still embrace this newly drastically limited “me” has been a time, I won’t lie… A lifetime spent going 90-nothing and now getting slapped on wrists (aka shut down for a day or two after over doing it…physical exertion). But how can someone possibly “get used to” having muscle spasms to point of muscles swelling at base of head (where neck meets) to the point of leading to migraines, including failed attempts of balancing control with tens unit (from PT), soaking in hot jacuzzi tub at home, medications, and such? It is to the point of weather and barometric pressure effecting also and having to get as still as possible and taking double or triple my dose of muscle relaxers to try getting the spasms to stop and then tackle the muscle swelling. When the migraine is reached and reaches a certain point, it lingers for 3 days. The fibro flare ups I haven’t noticed in my case as being linked, but have noticed besides weather, physical or emotional or psychological overexertion/stressing has been a major contributing factor, but everyday life has these instances, even absent working now, the stress from the remaining distant process of my attorney getting my disability claim processed and all beforehand I have any income at all while not feeling like a failure (being forced to quit work & my degree I worked on from 2010-2016 and majority of some daily life activities) and not losing everything I have in my name in this process…. No rest for the wicked is what I tell some of my friends, just to get a laugh.

  2. drscareme says:

    I have very similar problems for about 5 years now. Used to get headaches with just pain in one temple or the other…always related to my cycle. One dr. says sinus migraine, one says migraines, etc…Used Imitrex for years. Stopped after reading scary stuff about it.

    Hot water bottle on that side seems to help a bit..usually helps me to sleep anyway. Occasionally ice will work, but hard to tolerate.

    Then started getting these horrible pains in my neck and shoulders before (usually) or during a one-sided headache…same side as the spasm.

    I have also tried exercise, stretching, etc. If I take 4 motrin is sometimes cuts the pain, other times nothing. Same thing with execedrin. But if I take too late in the day I can’t sleep.

    I have read a few articles saying that long term Imitrex (or similar) drugs can not only cause rebound headaches, but damage bones in the neck and spine. Also lots report tingling in the face and sinuses so I have to wonder if these have been damaged due to my long term use of this “wonder drug”.??

    I have started seeing a massage therapist and it seems to have helped a little. Kind of too soon to tell. I also went to a GOOD chiropractor and have had neck adjustments.

    I don’t think this is fibromyalgia. I don’t have the other symptoms of it. I am in peri-menopause so hard to tell what my cycles are doing..all over the place. But have still seen some of these headaches/spasms around the time a cycle has started or when I would of been ovalating.

    Also, my neck gets very “cracky” when I have these…don’t understand why..But it will feel like a need to “pop” it into place.around the base of the head. Also pain there too. And last strange thing that started around the same time…cheek pain. Do you have that?

    I broke my nose almost 5 years ago and that is when the cheek pain started. Used to be only on the right, now I get it on the left too if that is the side of the trouble. Also sometimes my eyes feel pressure behind them. They will water sometimes.

    Are we nuts. I did read an article some years ago about water weight during cycle causing pressure on the muscles in and around the neck and down towards the breasts. Fluid retention in that area presses on these muslces and causes spasms. Interesting. I’ll see if I can find it again. I think the condition even had some technical name. When I asked my Dr. she looked at me like some kind of a nut.

    I am hoping more will reply to our posts now. I did find another site talking about face and cheek pain. Will post that link too if I can dig it up.

    Good luck.
    Feel free to contact me if you want to share notes.

    J 🙂

  3. drscareme says:

    Also, hormone testing can be difficult as I guess many little “sub-levels” of estrogens, progesterones, etc.

    I just did saliva testing…supposed to be more accurate than blood work. Will see.

    I also have one of those little electric zapping things that sometimes helps if I get to it in time…but usually don’t have that option. And once they start, man they are in for the long haul…usually 12-24 hours.

    I agree…Drs. want to call chronic headaches migraines, prescribe imitrex type drugs or scary stuff to try to prevent. Mine wanted to put me on Zoloft. I said when I go throw menopause can I come off and see how the head is? She says, oh no..once you go on you are on for life…sorry,not for me…who knows what the long term side effects of that will be.

    Going to go and see if I can find that article about the pressure on the shoulders and water weight. I know I printed it out.

    Thanks for the reply.>>Sounds like we are very similar. I am 47 and in peri-menopause for about 5 years. Drs. didn’t believe me until one blood test showed my level of LSH (I think) was POST-menopausal..that could explain lack of cycles for months at a time…like I don’t know my own body..that makes me so mad!

  4. drscareme says:

    check out:

    look under muscle contraction…

    could explain a little of our issues.

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