Brain & Nervous System Migraines Related Conditions Migraines With Fibromyalgia and Chronic Fatigue Syndrome By Adrienne Dellwo Updated on July 02, 2022 Medically reviewed by Nicholas R. Metrus, MD Print Table of Contents View All Table of Contents Symptoms Causes Treatment Diagnosis When to See a Healthcare Provider Frequently Asked Questions Migraines are common in people with fibromyalgia and chronic fatigue syndrome. In fact, a headache of a new type, pattern, or severity is one of the diagnostic criteria for chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME/CFS). Fibromyalgia and ME/CFS are medically unexplained syndromes—known as functional somatic syndromes—that can often co-occur. While chronic pain and fatigue are common with both, pain is the predominant feature of fibromyalgia and fatigue is the predominant feature of ME/CFS. Migraines are just one of the symptoms that connect the two conditions. This article explores the link between migraines and fibromyalgia or chronic fatigue syndrome. It also explains how you can treat and prevent migraines with medications and lifestyle. Differences Between Migraines and Headaches Symptoms of Migraines With Fibromylagia and ME/CFS Migraines that occur with fibromyalgia or ME/CFS are largely the same as those that occur without. The main difference is that migraines tend to occur more frequently or more severely when fibromyalgia or ME/CFS are involved. A 2018 study in the Journal of Headache and Pain concluded that people with fibromyalgia have more intense and severe migraine headaches than those without. They are also more likely to experience depression as a result of their migraine. A similar study in BMC Neurology reported that people with ME/CFS were nearly 17 times more likely to experience migraines compared to people without ME/CFS. Moreover, the symptoms tend to be worse, often with a visual disturbance called an aura. Additional symptoms include poor memory, dizziness, numbness, and heart palpitations. Based on the current body of research, symptoms of migraine in people with fibromyalgia and ME/CFS frequently include: Intense throbbing or aching pain on one or both sides of your headPain that worsens with physical activityNausea or vomitingBlurred vision or blind spotsExtreme sensitivity to light, noise, or smellsFeeling persistently tiredConfusion or memory problemsStuffy noseFeeling cold or sweatyNumbnessStiff or tender neckLightheadedness or dizzinessTender scalpChest painHeart palpitationsAura (flashing lights or zigzag lines preceding migraine headaches) What Are the Different Types of Migraine? Causes of Migraines With Fibromyalgia and ME/CFS Fibromyalgia and ME/CFS belong to a group of illnesses referred to as central sensitivity syndromes (CSS). These are illnesses with physical symptoms that cannot be totally explained or diagnosed as an established medical condition. In addition to fibromyalgia and ME/CFS, other disorders that fall under the umbrella of CSS include irritable bowel syndrome (IBS), chronic headache, temporomandibular disorders (TMD), and chronic pelvic pain syndrome (CPPS). Pain is a central feature of all CSS disorders. Fatigue, headaches, sleep problems, dizziness, depression, anxiety, and problems with attention, memory, or concentration are also common. For reasons unknown, CSS causes your central nervous system to become abnormally sensitive to stimuli that wouldn't normally cause pain. The amplified pain response, referred to as allodynia, is thought to involve both psychological and physiological causes. Illustration by Cindy Chung, Verywell There are several hypotheses as to the root cause of allodynia in people with fibromyalgia and ME/CFS: Neuroplasticity: The normal pathways of the central nervous system (the brain and spinal cord) may be disrupted in people with fibromyalgia or ME/CFS, leading to the "mistranslation" of pain signals. The reorganization of nerve pathways, referred to as neuroplasticity, may "rewire" the brain and/or make nerves more excitable. Impaired stress response: The body's stress response system, particularly the hypothalamic-pituitary-adrenal (HPA) axis, may be impaired in people with fibromyalgia and ME/CFS. This can decrease the amount of a stress hormone called cortisol released into the body. This, in turn, increases the likelihood of chronic pain. What is not entirely clear is whether migraines are "caused" by CSS disorders like fibromyalgia and ME/CFS or are simply amplified by them. It may be a bit of both given the high incidence of migraines with both conditions. Some studies suggest that over eight of every 10 people with ME/CFS experience migraines, while more than five of every 10 people with fibromyalgia also have migraines. How Migraines Are Treated With Fibromyalgia and ME/CFS The treatment of fibromyalgia and ME/CFS is largely focused on the management of symptoms. This includes keeping on top of your headache pain. To this end, there is a wide range of options you can turn to if you suffer from chronic migraines. Over-the-Counter Medications Some of the more common over-the-counter (OTC) drugs used to treat moderate migraines include: Non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin (ibuprofen), Aleve (naproxen), and aspirin Tylenol (acetaminophen), a non-NSAID pain reliever List of Recommended Migraine Medications Prescriptions Prescription medications may be recommended when OTC painkillers fail to provide relief or when migraine attacks are frequent and severe. Some of these drugs can be used to treat multiple symptoms of fibromyalgia or ME/CFS, not just headache pain. Medications used to treat migraine episodes include: Prescription NSAIDs such as Cambia (diclofenac) as well as stronger formulations of ibuprofen or naproxen Triptans, a group of drugs like Imitrex (sumatriptan), Axert (almotriptan), and Relpax (eletriptan) commonly used to treat migraine pain and cluster headaches Migranal (dihydroergotamine), a painkiller delivered by nasal spray DHE 45 (dihydroergotamine), an injectable version of Migranal Antiemetics, a group of drugs like chlorpromazine and Haldol (haloperidol) that reduce nausea associated with migraines Medrol (methylprednisolone), a steroid drug delivered intravenously (into a vein) for severe migraines in an emergency room or hospital setting The drugs used to prevent or reduce the frequency of migraines attacks include: Biologic drugs such as Aimovig (erenumab) and Ajovy (fremanezumab-vfrm) Beta-blockers like Inderal (propranolol) and Toprol (metoprolol) Antidepressants such as Elavil (amitriptyline) Anticonvulsants like Neurontin (gabapentin), Depakote (divalproex), and Topamax (topiramate) Types of Medications That Prevent Migraines Lifestyle Changes Lifestyle changes can also play a significant role in the management of migraine symptoms if you have fibromyalgia or ME/CFS. These include: Diet changes: Certain foods or drinks can trigger headaches. Keeping a food diary and identifying food triggers can help reduce the frequency of attacks. Exercise: While exercise is generally beneficial to one's health, it can be tricky when you have fibromyalgia or ME/CFS. Be sure you're not making things worse by overdoing it. Stress reduction: Learning to manage your stress can also help, especially since stress is a major trigger for headaches and migraines. How Migraines Are Treated Are There Tests to Diagnose the Cause of Migraines? There are no specific tests to diagnose migraines. To ensure an accurate diagnosis, your healthcare provider will review your pattern of recurring headaches along with associated symptoms like nausea, vomiting, and auras. Similarly, there are no diagnostic tests for fibromyalgia or ME/CFS. The diagnosis relies heavily on a physical exam, a review of your medical history, and a sometimes-exhaustive list of tests and procedures to rule out other possible causes. With that said, there are criteria by which fibromyalgia and ME/CFC can be reliably diagnosed. The diagnosis wouldn't necessarily alter how migraines are treated, but it can help build a treatment plan that may better help control pain episodes in general. The following only covers some of the key criteria used to diagnose fibromyalgia and ME/CFC: Diagnostic Criteria for Fibromyalgia Severe pain in three to six different areas of your body, or milder pain in seven or more different areas Symptoms persist at a similar level for at least three months No other causes of your pain can be found Diagnostic Criteria for ME/CFS Six months or more of profound, unexplained fatigue A general feeling of unwellness (malaise) that persists more than 24 hours after mental or physical exertion Unrefreshing sleep or the inability to fall or stay asleep Persistent loss of mental concentration ("brain fog") No other causes of your fatigue can be found When to See a Healthcare Provider If left untreated, migraines can reduce a person's quality of life and ability to function normally. Migraines can also compound the challenges already faced by people living with fibromyalgia and ME/CFS. You should seek immediate medical attention for a migraine if: Your headache lasts for more than 72 hours.You lose vision or consciousness or have trouble speaking.You have uncontrollable vomiting.Your headache develops suddenly and reaches maximum intensity within a minute or two. Summary Migraines are common in people with fibromyalgia and chronic fatigue syndrome. Not only do they occur more frequently, but they tend to be more severe. The cause of migraines in people with fibromyalgia and chronic fatigue syndrome is unknown. With that said, both conditions are associated with pain hypersensitivity may increase the intensity and perhaps frequency of migraine attacks. Migraines are treated no differently in people with fibromyalgia or chronic fatigue syndrome than anyone else. Even so, an effective treatment plan for fibromyalgia or chronic fatigue syndrome will often reduce pain episodes that may contribute to migraine pain. A Word From Verywell Patience is required when undergoing the diagnosis of fibromyalgia or chronic fatigue syndrome. Finding an effective treatment can also take time and often requires a process of trial and error. If you are not getting the results you want, do not hesitate to seek a second opinion. Ask your primary care provider for a referral to a certified neurologist (who specializes in disorders of the nervous system) or a rheumatologist (who specializes in the treatment of rheumatic diseases) in your area who can help. Frequently Asked Questions How common are migraines in people with chronic fatigue syndrome? According to researchers at Georgetown University in Washington, D.C., 84% of people with chronic fatigue syndrome experience migraines. The majority of these will experience visual disturbances, known as auras, prior to the onset of migraine pain. How do migraines differ in people with fibromyalgia? Studies suggest that people with fibromyalgia experience migraines far more intensely and are more likely to experience depression as a result. It is thought that nerve hypersensitivity characteristic of fibromyalgia heightens the perception of pain both physically and psychologically. Learn More: The Link Between Depression and Chronic Pain What is most effective treatment for migraines with fibromyalgia? Some studies suggest that a class of antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs) can not only help prevent migraines but treat other pain symptoms associated with fibromyalgia. Options include SNRIs like Cymbalta (duloxetine) and Effexor (venlafaxine). 17 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Karsan N, Goadsby PJ. 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Pain Res Manag. 2020;2020:6541798. doi:10.1155/2020/6541798 Additional Reading Bourke JH, Langford RM, White PD. The Common Link Between Functional Somatic Syndromes May Be Central Sensitisation. Journal of Psychosomatic Research. 2015 Mar;78(3):228–36. doi: 10.1016/j.jpsychores.2015.01.003. Kucuksen S, Genc E, Yilmaz H, et al. The Prevalence of Fibromyalgia and Its Relation With Headache Characteristics in Episodic Migraine. Clinical Rheumatology. 2013 Jul;32(7):983–90. doi:10.1007/s10067-013-2218-2. Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification. The Journal of Pain. September 2016;17(9):T93–T107. doi:10.1016/j.jpain.2016.06.002. By Adrienne Dellwo Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! 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