Headaches and Migraines in Fibromyalgia and Chronic Fatigue Syndrome

Headaches and migraines are common in people with fibromyalgia and chronic fatigue syndrome, also known as myalgic enscephalopmelitis (ME/CFS). In fact, headaches of a new type, pattern, or severity is one of the diagnostic criteria for ME/CFS. Sometimes headaches are treated as a symptom of these conditions, while sometimes they're considered a comorbid condition.

Here's a look at the link between these three conditions, as well as how you can treat and manage them.

How They're Connected

Fibromyalgia and ME/CFS belong to a group of illnesses that have been labeled with several different umbrella terms, including functional somatic syndromes and somatic illnesses. Another term that has gained more prominence in recent years is central sensitivity syndromes. These syndromes are defined as illnesses with physical symptoms that can't be totally explained or diagnosed as an established medical condition.

Migraine has long been associated with functional somatic syndromes, including ME/CFS and fibromyalgia, meaning that the conditions often occur together. Although it's still unclear why this happens, researchers are looking into the possibility that one of the underlying mechanisms the three conditions may share is central sensitization.

functional somatic syndrome
Illustration by Cindy Chung, Verywell

Central sensitization is associated with a number of illnesses, including mental health disorders, and occurs after repeated exposure to certain stimuli like touch, noise, light, temperature, fragrance, and chemicals. Gradually, your central nervous system becomes abnormally hypersensitive to a stimulus or stimuli (the culprits can vary from person to person), intensifying your pain.

Scientists are still trying to understand exactly what causes central sensitization, but it seems to have both a biological and a psychosocial basis. So far, the hypotheses include:

  • Inflammation
  • Dysregulation in the pathways of the central nervous system
  • A dysfunctional stress response system, particularly in the hypothalamic-pituitary-adrenal (HPA) axis
  • Dysregulation of the autonomic nervous system, which controls automatic functions such as breathing, heart rate, and digestion
  • Changes in how the brainstem processes stimuli

One manifestation of central sensitization is called allodynia, a type of pain that occurs in response to a stimulus that wouldn't normally cause pain, usually touch. Allodynia is associated with migraine, fibromyalgia, and sometimes ME/CFS.

It will be interesting to see what future research on the link between migraine, fibromyalgia, and chronic fatigue syndrome reveals, particularly as it relates to central sensitization.

Treating Headaches & Migraines

Because treating fibromyalgia and ME/CFS involves managing your symptoms, keeping on top of your head pain is crucial. The types of headaches that may be present in fibromyalgia and ME/CFS include tension headaches and migraines. Thankfully, there is a wide range of options when it comes to treatment.

Over-the-Counter Medications

Over-the-counter drugs for treating headaches and migraine include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen), Aleve (naproxen), and aspirin
  • Pain relievers like Tylenol (acetaminophen) and Excedrin (aspirin/paracetamol/caffeine)

Of these, Tylenol may be the least effective against severe headaches.

Prescription Medications

Healthcare providers sometimes prescribe medications for migraines when over-the-counter medications just don't cut it. These drugs include:

  • Prescription analgesics such as Cambia (diclofenac) and stronger formulations of ibuprofen or acetaminophen
  • Triptans like Imitrex (sumatriptan), Axert (almotriptan), Relpax (eletriptan), Maxalt (rizatriptan), and Zomig (zolmitriptan)
  • Migranal (dihydroergotamine), an ergot alkaloid
  • Antiemetics such as chlorpromazine, Haldol (haloperidol), and metoclopramide
  • Corticosteroids

Preventing Headaches & Migraines

More important than treating headaches when you have them is preventing them from happening in the first place, especially because minimizing head pain may help decrease your fibromyalgia and ME/CFS symptoms as well.


Medications that your healthcare provider can prescribe to help reduce the frequency of your migraines include:

  • Biologics, such as Aimovig (erenumab) and Ajovy (fremanezumab-vfrm)
  • Beta-blockers like Inderal (propranolol), Toprol (metoprolol), and timolol
  • Antidepressants, such as amitriptyline
  • Anticonvulsants like Neurontin (gabapentin), Depakote (divalproex), and Topamax (topiramate)

Some of these abortive and preventive medications are also used to treat symptoms of fibromyalgia and chronic fatigue syndrome, so one treatment might help multiple conditions. That said, it's important to remember that no single treatment is likely to alleviate all of your symptoms when you're trying to treat more than one condition.

When you're taking multiple medications, it's important to talk to your healthcare provider and/or your pharmacist about possible side effects and drug interactions.

Non-Pharmacologic Measures

Beyond preventive medication, some other measures that may help prevent headaches and migraines include:

As with the medications, some of these treatments may also help with symptoms of fibromyalgia and ME/CFS.

Lifestyle Changes

Lifestyle changes can play a big role in your migraine-fibromyalgia-ME/CFS treatment as well, including:

  • Diet changes: You may find that certain foods or drinks trigger your headaches, which makes avoiding them important to how you feel.
  • Exercise: While exercise helps some people, it's tricky when you have fibromyalgia or, especially, ME/CFS. Be sure you're not making yourself worse by overdoing it.
  • Stress reduction: Learning to manage and reduce your stress can also help, especially since stress is a major trigger for headaches and migraines.

A Word From Verywell

Managing one condition tends to be difficult, and having more of them can complicate things. Working to actively treat and manage all of your conditions and, in general, live a healthy lifestyle, may make a noticeable difference in your quality of life. Fortunately, in the case of migraine, fibromyalgia, and ME/CFS, you may be able to get double-duty from several treatments and preventative measures. If you have problems with headaches or migraines, talk to your healthcare provider so you can get a diagnosis and start looking for effective treatments.

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