Migraines With Fibromyalgia and Chronic Fatigue Syndrome

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.

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 head
• Pain that worsens with physical activity
• Nausea or vomiting
• Blurred vision or blind spots
  
• Extreme sensitivity to light, noise, or smells
• Feeling persistently tired
• Confusion or memory problems
• Stuffy nose
• Feeling cold or sweaty
• Numbness
• Stiff or tender neck
• Lightheadedness or dizziness
• Tender scalp
• Chest pain
• Heart palpitations
• Aura (flashing lights or zigzag lines preceding migraine headaches)

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.

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.

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

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)
  

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.

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:

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.