Fibromyalgia and Migraine: How Are They Linked?

Living with either migraine or fibromyalgia is a challenge on its own. They are both pain disorders that have been found to be linked. This means that fibromyalgia and migraine can cooccur and thus lead to a fair amount of pain.

Fibromyalgia and migraine have several factors in common. They both have similar symptoms, such as headaches, gastrointestinal issues, and sensitivity to noise or light. In addition, they both occur more in women than men.

In this article, we will take a look at how migraine and fibromyalgia are linked. We will also dive into some of the treatment options for these conditions.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain disorder that is characterized by chronic, widespread musculoskeletal pain, or pain all over the body, accompanied by debilitating fatigue, mood disorders, cognitive difficulties, sleep problems, and headaches. Those with fibromyalgia often are more sensitive to pain than those without.

The most prominent symptom of fibromyalgia, widespread chronic pain, has a neurogenic origin. The pain seems to be due to neurochemical imbalances in the central nervous system associated with the central amplification of pain perception. This is characterized by allodynia, increased sensitivity to normally painless stimuli, and hyperalgesia, heightened response to painful stimuli. Stimuli are abnormally processed in the central nervous system.

Fibromyalgia affects around 4 million US adults, which is about 2% of the adult population. It is more prevalent in females than males. Despite the recent increase in understanding and awareness, fibromyalgia remains undiagnosed in around 75% of those with the disorder.

The cause of fibromyalgia is not always known. Many experts believe that repeated nerve stimulation causes a change in the brain and spinal cord of people with fibromyalgia. Sometimes genetics can play a role. Certain conditions or events could also bring on symptoms of fibromyalgia. Stressors (such as traumatic life events like abuse and accidents), psychological stress, medical conditions like infections or other illnesses, lack of exercise, or poor sleep can contribute to the development of fibromyalgia.

Symptoms might accumulate gradually over time or begin after a certain event. Common fibromyalgia symptoms include pain and stiffness in all of the body, headaches, tiredness and fatigue, depression, anxiety, sleep issues, and cognitive difficulties. Many other conditions could coexist with fibromyalgia, such as migraine, irritable bowel syndrome (IBS), chronic fatigue syndrome, temporomandibular joint disorders, painful bladder syndrome, interstitial cystitis, or postural tachycardia syndrome. However, fibromyalgia can often be effectively managed and treated.

The Link Between Fibromyalgia and Migraine

As mentioned earlier, headaches are a major symptom of fibromyalgia. Migraine is a type of headache that affects 12% of the population. It is a complex, recurrent disorder that is characterized by a throbbing headache and is often associated with allodynia, nausea, and sensitivity to light or sound.

Fibromyalgia and migraine disease are quite debilitating on their own. However, researchers have found a 2-way association between the onset of fibromyalgia in patients with migraine and the onset of migraine in those with fibromyalgia. Fibromyalgia and migraine are two common pain disorders that frequently coexist. This suggests that these conditions have common pathophysiological mechanisms. However, researchers are unsure why migraine and fibromyalgia tend to co-occur so often.

As both migraine and fibromyalgia are debilitating pain disorders, if present together, they can add to each other’s morbidity and thus significantly affect the quality of life of patients. Several studies reported that high proportions, around 20%–36%, of patients with migraine also have fibromyalgia. In patients with fibromyalgia, the frequency of migraine is between 45%–80%.

Impact of Migraine on Fibromyalgia

It is common for individuals with migraine to have comorbidities; however, there seems to be a significant symptomatic link with fibromyalgia. There’s a high prevalence of fibromyalgia in patients who suffer from migraines.

A 2018 study found that 36.2% of migraine patients met the diagnostic criteria for fibromyalgia. Compared to those with migraine disease alone, those who had both migraine and fibromyalgia had higher rates of sleep disruption, depression, and anxiety. In addition, lower quality of life was found among those patients. This makes screening for fibromyalgia symptoms in the migraine population essential.

Migraine and fibromyalgia have been found to have several overlapping symptoms, causes, and treatments. Central sensitization plays a role in chronic migraine and fibromyalgia. A question raised by research is whether both conditions together result in higher degrees of central sensitization compared to one condition alone. The causes of either condition are not clear, however it has been speculated that they are related to problems with the nervous system’s pain processing.

Migraine pain is said to be due to the nociceptive activation of the trigeminovascular system that modulates central signals to numerous subcortical sites. Tonic nociceptive input with central disinhibition may be associated with fibromyalgia development.

A common condition experienced by migraineurs during a migraine attack is allodynia. With migraines, allodynia is often confined to the head and neck but could include other body areas. In addition, peripheral tissues have been shown to contribute to painful impulse input and have the ability to maintain or initiate central sensitization. This contributes to the progression of fibromyalgia.

Migraines and migraine attacks are said to trigger fibromyalgia. Repeated headaches in people with migraine disease may increase sensitivity to fibromyalgia. In addition, studies have found significantly increased headache instances and migraine severity in patients with comorbid fibromyalgia. Also, chronic migraine has been reported to increase pain episodes in those with fibromyalgia.

Impact of Fibromyalgia on Migraine

At least half of the patients with fibromyalgia report headache as a major symptom. A 2015 study found that the prevalence of migraine in those with fibromyalgia was 55.8 %. The frequency of migraine in fibromyalgia ranges from 45% to 80%. In addition, researchers have found that as patients with fibromyalgia age, they become more likely to develop migraine disease.

Early in the course of fibromyalgia, musculoskeletal pain seems to appear in the neck or shoulder area. The neck pain may induce a migraine attack. Some researchers believe that migraine and fibromyalgia are linked due to defects in the brain’s systems that regulate specific chemical messengers.

Both fibromyalgia and migraine disproportionately affect women. This may partially explain their coexistence.

Interventions That May Improve Fibromyalgia and Migraine

There is a high disease burden on patients living with migraine and fibromyalgia. If you have fibromyalgia symptoms with episodic or chronic migraine, it is crucial to screen for fibromyalgia.

It is critical to treat these comorbidities. However, this could be tricky. Technically, attack prevention and trigger management are essential treatments for the two disorders. In addition, migraine-specific medication or supplements that can reduce attacks may be options for decreasing fibromyalgia flares.

Despite having no cure, fibromyalgia has certain medications that could help with symptom management. Other measures, such as exercise, stress reduction, and relaxation could also help.

Pharmaceutical Drugs:  Medications that have often been prescribed to address symptoms include antidepressants known as Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), such as  Cymbalta (duloxetine), could be used to address the conditions. Antiseizure medications, like Neurontin (gabapentin) or Lyrica (pregabalin), may also help ease pain but these medications are not without side effects.

Behavioral Therapies and Lifestyle Interventions: Stress management through behavioral therapies can be beneficial. Lifestyle interventions can also help with fibromyalgia and migraine disease. Getting enough sleep, following a healthy diet, staying hydrated, exercising, and staying active are a couple of habits that could be adopted to help improve the conditions.  Acupuncture may also help with fibromyalgia.  A study of 395 participants found some evidence that acupuncture may help improve pain and stiffness.

Dietary Supplements: Some of the dietary supplements being investigated for relieving fibromyalgia symptoms include

• Vitamin D – Be sure to have your vitamin D levels checked by your physician as fibromyalgia has been attributed by some researchers to vitamin D deficiency.  Vitamin D is great for overall health and avoiding sickness.
• Magnesium – Research also suggests that many people with fibromyalgia have low levels of magnesium.  A review of the scientific literature suggests magnesium supplementation may provide effective nutritional support to people with fibromyalgia.
• 5-HPT (5 hydroxytryptophans) – According to a review published in Rheumatology International, studies suggest 5-HTP may help improve fibromyalgia symptoms. 5-HTP is a natural amino acid. It helps your body produce serotonin. This chemical helps regulate your mood.  It may help relieve pain, morning stiffness, fatigue, and anxiety. More research is needed, but scientists believe it works similarly to anti-depressants.
• S-adenosyl-L-methionine (SAMe) – S-Adenosyl methionine (SAMe) is a molecule that your body produces naturally and is available as a dietary supplement.  SAMe was found in a scientific review to help relieve pain, morning stiffness, and fatigue.
• Creatine – Creatine has also been shown in recent studies to help with symptoms of fibromyalgia. Creatine is an organic acid that your body uses to produce energy in the form of adenosine triphosphate (ATP). Fibromyalgia is believed to involve low levels of ATP.  A study showed adding creatine to your diet may strengthen muscles and improve neuromuscular function in people with fibromyalgia.

TAKEAWAY

Fibromyalgia is a chronic pain disorder that is characterized by widespread musculoskeletal pain accompanied by debilitating fatigue, mood disorders, cognitive difficulties, sleep problems, and headaches.

Fibromyalgia and migraine disease are debilitating on their own. However, they can occur together, which makes symptoms of both worse. Migraines can trigger fibromyalgia and vice versa. Certain medications, behavioral therapies, or lifestyle interventions could help ease the burden of the coexisting conditions.  If standard medications aren’t giving you the relief you need, talk to your doctor about complementary therapies. Dietary supplements, massage therapy, yoga, acupuncture, meditation, or other options may help you feel better.