The Relationship Between Migraine and Fibromyalgia
Written by: Kylie Petrarca RN, BSN
Medically Reviewed by: Dr. Jessica Ailani
Edited by: Melissa Calise and Leigh Serth
What is Fibromyalgia?
Fibromyalgia (FM) is a chronic condition that causes widespread pain, primarily affecting the muscles, bones and joints. People with this disease experience a hypersensitivity to both painful and non-painful stimuli. People may experience other associated symptoms such as sleep disturbances, brain fog, memory impairment, headache, fatigue as well as numbness and tingling of the extremities. It is often comorbid with anxiety and/or depression. It is unknown why fibromyalgia occurs but it is believed to be a disorder of abnormal pain regulation and central sensitization. The central nervous system which includes the brain and the spinal cord may be hyperactive or overly sensitive to stimuli.
FIBRO = fiber, MY= muscle, ALGIA = pain
How are Fibromyalgia and Migraine Related?
A large epidemiological study found, “a 55.8% prevalence of migraine among fibromyalgia patients, while other studies showed the prevalence of fibromyalgia in migraine patients to be over 30%.”1
It is unclear if migraine triggers fibromyalgia or fibromyalgia triggers migraine but there are cases that have been made for both.
Migraine triggering fibromyalgia: One belief is that repeated headaches in patients with migraine may change the way neurons respond to painful stimuli and cause spontaneous neural activity in the central nervous system therefore increasing the chances of developing fibromyalgia.2
Fibromyalgia triggering migraine: In the beginning stages of fibromyalgia, musculoskeletal pain appears in the neck and shoulder region which may activate painful sensory stimuli and transmit pain impulses through the upper cervical spinal nerves and into the trigeminal nucleus caudalis thereby triggering a migraine attack.2
Commonalities Between Migraine and Fibromyalgia
- Both conditions are associated with abnormal levels of serotonin and norepinephrine. The underlying pathophysiology may be similar among those with migraine and fibromyalgia as both conditions respond to medications that increase serotonin and norepinephrine levels such as SNRI’s. Also, both conditions are commonly comorbid with anxiety and depression which are also associated with lower neurotransmitter levels.
- Central sensitization is a state where the central nervous system (brain and spinal cord) is hypersensitive to stimuli. This manifests in migraine disease where many people experience light and sound sensitivity and in fibromyalgia where people experience widespread pain and sensitivity to touch. Additionally, allodynia or pain caused from a stimulus that wouldn’t normally cause pain is a characteristic of both fibromyalgia and migraine.
Fibromyalgia and Tension-Type Headache
Tension-type headache presents as a pressure or squeezing type of pain across the forehead, on the sides of the head and/or in the back of the head to the neck. The pain is usually bilateral, or occurring on both sides. Some people describe the feeling as a tight band around their head. “Tension-type headache was the most common primary headache associated with FM, with a 59.01% prevalence.”3 It is unclear why tension headaches occur so commonly with fibromyalgia but two common triggers are stress and stiff neck muscles.
Diagnosis and Treatment of Fibromyalgia and Migraine
Neither migraine or fibromyalgia have tests that allow for a definitive diagnosis. They are both diagnosed by a health care provider through physical examination, history-taking, laboratory tests and exclusion of other diseases. Diagnosis of fibromyalgia is likely if the person is sensitive in at least 11 of the 18 tender points in the body and experiences widespread pain in all four quadrants of the body. The four quadrants include the right and left sides of the body above the waist and the right and left sides below the waist. When a physician presses on these 18 tender points, a person with fibromyalgia may feel pain while a person without the condition would feel pressure.
Tricyclic antidepressants like amitriptyline are commonly used as the first line treatment for fibromyalgia and are used as second line medications for migraine. Muscle relaxers such as cyclobenzaprine are also commonly used for fibromyalgia. If one therapy alone is not effective then combination therapy is explored with SSRIs, SNRI’s, nerve pain medications, tricyclic antidepressants and/or anticonvulsants. A health care provider will determine which combination of medications would be the most effective for the patient. Interestingly, SNRI’s, tricyclic antidepressants and anticonvulsants are all used as preventive medications for migraine as well. Magnesium is also commonly used as a preventive medication for migraine and is also used for fibromyalgia. It’s been found that low levels of magnesium can exacerbate fibromyalgia symptoms.2 An interesting discovery by researchers is that “people who do not respond to standard migraine treatments often also have FM.”2
Other therapies for fibromyalgia and migraine may include trigger point injections with anesthetics, botox and/or steroids. A person with fibromyalgia may require a referral to a dietician due to numerous food intolerances that often occur in those with this condition. It is important that those with fibromyalgia and migraine have a regular sleep routine meaning they go to the bed and wake up at the same times each day. Patients should abstain from using their phones and watching TV before bed, and avoid caffeine, exercise and alcohol after 5 p.m. Regular mild to moderate intensity exercise is beneficial. Consulting a physical therapist would be helpful in creating a customized exercise plan that is beneficial for fibromyalgia patients who have increased pain with activity. Routine exercise is also recommended for migraine, although, for some it may cause increased head pain so it is important to find the right types and intensity of exercise.
What Type of Doctor Should I See for Migraine and Fibromyalgia?
Migraine is best treated by a clinician that specializes in headache medicine. A rheumatologist is the preferred specialist for diagnosis and treatment of fibromyalgia. Similar to migraine, many primary care physicians and neurologists are able to diagnose and treat FM. Also, a psychiatrist or psychologist may be useful to help combat the anxiety and depression commonly seen in both conditions. A physical therapist may be involved to help with creating an exercise plan for those with fibromyalgia and/or migraine.
Overlapping Comorbid Conditions
In addition to depression and anxiety, fibromyalgia and migraine are also both commonly comorbid with chronic fatigue syndrome, rheumatoid arthritis, systemic lupus erythematosus, irritable bowel syndrome, Raynaud’s phenomenon, interstitial cystitis, vulvodynia, obesity and endometriosis.
A Note to Patients and Providers
It is important for physicians to screen those living with migraine disease for fibromyalgia and vice versa. It may be helpful for physicians to use a symptom-based screening tool to assess for overlapping conditions. Signs and symptoms of migraine should be reported to a provider if they occur. More research is needed for fibromyalgia, therefore those with the condition are encouraged to enroll in clinical trials by routinely checking clinicaltrials.gov.
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- Giamberardino, M.A., Affaitati, G., Martelletti, P. et al. Impact of migraine on fibromyalgia symptoms. J Headache Pain 17, 28 (2016). https://doi.org/10.1186/s10194-016-0619-8
- Penn, I. W., Chuang, E., Chuang, T. Y., Lin, C. L., & Kao, C. H. (2019). Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ open, 9(4), e026581. https://doi.org/10.1136/bmjopen-2018-026581
- de Tommaso, M., Federici, A., Serpino, C., Vecchio, E., Franco, G., Sardaro, M., Delussi, M., & Livrea, P. (2011). Clinical features of headache patients with fibromyalgia comorbidity. The journal of headache and pain, 12(6), 629–638. https://doi.org/10.1007/s10194-011-0377-6
*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.