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There’s something about migraines and fibromyalgia and chronic fatigue syndrome (ME/CFS). Migraines aren’t usually talked about as major comorbid disorders with these diseases but recent studies suggest, however, that migraine may be one of the most, if not the most, common comorbid disorder for both of these illnesses.  These studies – most of them fairly small – have suggested that from 20-30% of people with FM and as many of 80% of people with chronic fatigue syndrome may experience migraines.

tension type headaches fibromyalgia

Tension type headaches commonly co-occur with migraines in FM and ME/CFS

One study suggested that most people with ME/CFS, FM and/or GWI who experience tension headaches (dull head pain, pressure around the forehead, tenderness around the forehead and scalp) also experience migraines. Frequent tension headaches alone can induce an overall hypersensitivity to pain.

Perhaps because it was picked up by the medical community before “central sensitization disorders” like FM, IBS, interstitial cystitis and ME/CFS became known, migraine is not often included in that pack.  Migraine, though, appears to share similar central nervous system findings as other central sensitization disorders and it’s hard to think of a disorder in which hypersensitivity to outside stimuli plays a bigger factor – at least for a time – than migraine.

Migraine shares some other features with ME/CFS and FM; it largely strikes women, it most often appears during times of hormonal fluctuations, pregnancy often reduces symptoms, it can be triggered in many ways including stress and there’s a genetic and sometimes a relapsing/remitting component. People with ME/CFS and/or migraines typically retreat to the same environment – dark rooms – in order to recover.

It turns out that migraine sufferers don’t spontaneously recover from them.  In the days or week following a migraine many people with migraine can look very much like ME/CFS/FM patients.

One description of a typical “failed” migraine patient is instructive

“..a middle-aged woman with chronic migraine and medication overuse, as well as fibromyalgia. In addition, there is anxiety and depression, fatigue and insomnia, and the familiar exhaustive list of psychotropics and antiepileptic drugs tried and failed”

Now a very large study tells us definitively not only how common migraine is in fibromyalgia but what kind of burden it adds to the illness. It turns out that the burden is large indeed.

Frequency of Migraine Headaches in Patients With Fibromyalgia. Brinder Vij, MD, FACP; Mary O. Whipple, BSN, RN, CCRP; Stewart J. Tepper, MD; Arya B. Mohabbat, MD; Mark Stillman, MD; Ann Vincent, MD. Headache 2015; doi: 10.1111/head.12590

This study demonstrates how potent a tool patient registries can be.  In this REDCAP study, emails sent out to 4421 FM patients in a Mayo Clinic Patient Registry asked for demographic and medical information and included a validated “ID-migraine screener”.

The migraine screener simply asked if the participants headaches were associated with sensitivity to light, nausea and what kind of effect their headaches had on activity. A yes answer to two of the three questions indicated they met the criteria for migraine.

The diseases asked about included: hypertension, coronary artery disease, myocardial infarction, mitral valve prolapse, epilepsy, stroke, asthma, irritable bowel syndrome, gastrointestinal disorder, glaucoma, Raynaud’s phenomenon, chronic fatigue syndrome, depression, anxiety disorder, bipolar disorder, and post-traumatic stress disorder.

(Studies suggest that having fibromyalgia is associated with an increased risk of having  many other disorders including irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, sleep disorders, hypertension, type 2 diabetes, depression, and anxiety.)

Results

1730 people returned the questionnaire.  The demographics were familiar. Ninety-two percent of the participants were female, 97% were white, and the mean age was 56.

Some general findings stood out as well. Very high rates of depression, anxiety, chronic fatigue syndrome, irritable bowel syndrome and high rates of hypertension (something that’s probably at odds with ME/CFS), asthma and gastrointestinal disorders were found.

Migraines Very Common in Fibromyalgia

Fifty-six  percent met the criteria for migraines. (A higher percentage of FM patients met the criteria for migraines than had been diagnosed with ME/CFS.)

comorbid disorders fibromyalgia

The “penalty” for having migraines and fibromyalgia was a greatly increased chance of having other co-morbid disorders as well.

The “penalty” for having both fibromyalgia and migraine was a steep one. Women with FM and migraines had significantly higher chances of also having been diagnosed with hypertension (p<.004), asthma (p<.01), irritable bowel syndrome (p<.02), depression (p<.0002), anxiety   ( p<.001), PTSD (p<.005) and finally (and most of all) chronic fatigue syndrome (p<.0001).

Two disorders, in particular, stood out. The greatly increased risk people with FM have of being diagnosed with ME/CFS and/or depression, if they also experience migraines. ( Many doctors tendency to first misdiagnose FM and ME/CFS patients with a mood disorder could exaggerate the incidence of mood disorders).

That suggests, of course, a common pathophysiology is present.

Common Pathophysiology?

The high concomitance of fibromyalgia and migraine suggests that these pain disorders may share some degree of common pathophysiology. Authors

The author proposed it’s past time to take a deeper look at the commonalities in FM and migraine, and suggested a raft of possible factors that might fit:  alterations in neuroendocrine functioning, vascular (blood vessel) changes, immune activation, neuronal plasticity, nerve issues, hormonal influences (gender imbalance) and neurochemical alterations.

They’re not the first. Baraniuk, an ME/CFS, GWI and FM researcher finds similar kinds of altered brain structure and “brain energetics” in all these diseases.

“Similar patterns of gray and white matter abnormalities and altered brain energetics in GWI, CFS, FM, and migraine suggest that common central mechanisms may contribute to the type of headaches and cognitive impairments perceived as ‘brain fog’.

In fact, Baraniuk proposes that the hypoxic and anaerobic conditions that migraines and other disorders which feature cortical spreading depression (CSD) leave in their wake has become chronic in ME/CFS.  In other words, whether you experience migraines or not, Baraniuk believes your brain looks like you just had one.

Migraine Treatments

Migraine is not easy to treat but Baraniuk believes that migraine treatments can be helpful in both ME/CFS patients experiencing and not experiencing migraines and highlighted Imitrex  (sumatriptan).  Other (triptan) drugs include rizatriptan (Maxalt), naratriptan (Amerge, Naramig), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert, Almogran), frovatriptan (Frova, Migard, Frovamig), and avitriptan (BMS-180,048).

Sumatriptan

One doctor believes Sumatriptan could helpful in ME/CFS and FM patients not experiencing migraines.

Sumatriptan is a well-known anti-migraine drug that reduces inflammation in arteries and veins in the brain by enhancing 5-HT (serotonin) production. Increased 5-HT production causes over-dilated veins to constrict. Sumatriptan also deceases the activity of nerves called the trigeminal nerves that are associated with cluster headaches.

Dr. Katherine Downing-Orr features nimodipine, a calcium channel blocker used for migraine relief, in her treatment protocol for ME/CFS. Dr. Jay Goldstein also recommended nimodipine. Find out more about Nimodipine and ME/CFS/FM here.

Dr. Teitelbaum uses natural remedies including magnesium to get patients out of a migraine. Dr. Hyman also recommends magnesium and other factors (including CoQ10) depending on how the migraine is triggered.  (See Health Rising’s video section for more.)

Check out more possibilities for treating migraine including natural alternatives  – Migraines, Chronic Fatigue Syndrome and Fibromyalgia: Treatment Options

Poor Funding

One last commonality between ME/CFS, FM, migraine and other central sensitization disorders exists: poor funding. Despite the fact that approximately 20 million Americans suffer from migraine and that migraines cost the American economy about 30 billion dollars a year, migraines receive just 21 million a year in funding.  Per patient spending, per year on migraine is about the same as it is for fibromyalgia – about a dollar a year.

Diagnosis

Migraines are under-diagnosed but migraines can be self-diagnosed using a simple three question test.  Do you experience migraines? Find out and let us know here:

Chronic migraines are even less well diagnosed that migraines.  A new self-scoring questionnaire has been produce that diagnoses chronic migraines. Check out that questionnaire in the Resources section of the Health Rising Forums.

Migraine Video’s : Check out our extensive media section on migraines including more in depth discussions on pathophysiology and treatment.

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