Fibromyalgia and Migraine: Understanding the Connection

Fibromyalgia and migraine often occur together, with up to 30% of people with migraine also experiencing fibromyalgia as a comorbidity.

This guide explores what fibromyalgia is, its relationship with migraine, and how to manage these conditions effectively.

What is Fibromyalgia?

Fibromyalgia is a chronic pain condition characterized by widespread pain throughout the body. It can affect different regions such as the neck, back, arms, and legs, and is often accompanied by other symptoms like fatigue, cognitive difficulties (often called “fibro fog”), and sleep disturbances.

  • Old vs. New Definitions: Fibromyalgia was once defined by the presence of specific “trigger points” on the body that were painful when pressure was applied. The current definition focuses on widespread pain across multiple body regions and the impact of this pain on daily life.

Why Do Fibromyalgia and Migraine Occur Together?

There is a significant overlap between fibromyalgia and migraine:


    • Central Sensitization: This is a phenomenon where nerve cells, particularly those in the brain, become hypersensitive to pain signals. This can cause the entire body, not just the head, to become more sensitive to pain. Central sensitization is believed to be a key reason why fibromyalgia and migraine often occur together.
    • Bidirectional Relationship: Having one condition increases the likelihood of developing the other. For example, people with fibromyalgia are more likely to develop migraines, and vice versa.

Other Conditions Associated with Fibromyalgia

Fibromyalgia is commonly linked with other conditions, such as:

  • Ehlers-Danlos Syndrome (EDS): People with EDS, a connective tissue disorder, are 6-9 times more likely to have fibromyalgia. Both conditions involve widespread pain and are often intertwined.
  • Mental Health Disorders: Depression, anxiety, and other mood disorders are more common in people with fibromyalgia.

How is Fibromyalgia Diagnosed?

Diagnosis is typically made by a healthcare provider, often a rheumatologist, based on:

  • Symptoms: Widespread pain across multiple body regions and other symptoms like fatigue or cognitive difficulties.
  • Family History: A family history of fibromyalgia can increase the likelihood of diagnosis.
  • Genetic Factors: Genes related to serotonin, norepinephrine, and ion channels in nerve cells may predispose individuals to fibromyalgia.

Exercise and Lifestyle Recommendations for Fibromyalgia and Migraine

Exercise is an important part of managing fibromyalgia, but it must be approached carefully, especially when migraine disease is also present:

  • Light Exercise: Activities like walking, using a stationary bike, or isometric exercises (such as pushing against a wall) can help reduce symptoms.
  • Physical Therapy: May include techniques like dry needling to relieve muscle pain.
  • Healthy Lifestyle: An anti-inflammatory diet, proper sleep, hydration, and avoiding long fasting periods are also recommended.

Medications for Managing Both Conditions

Several medications may help manage both fibromyalgia and migraine:

  • Antidepressants: Such as tricyclic antidepressants (e.g., amitriptyline), SSRIs (e.g., fluoxetine), and SNRIs (e.g., duloxetine), which help increase serotonin and norepinephrine levels.
  • Anti-Seizure Medications: Such as gabapentin and pregabalin, which are FDA-approved for fibromyalgia.
  • New Treatments: Low-dose naltrexone, which blocks opioid receptors, is being explored as a potential treatment.

When to Talk to a Healthcare Provider

Consider consulting a healthcare provider if you:

  • Experience widespread pain across multiple body regions along with other symptoms like fatigue and cognitive difficulties.
  • Have a family history of fibromyalgia or notice worsening symptoms during periods of stress.
  • Need guidance on managing both fibromyalgia and migraine with a comprehensive treatment plan.

Fibromyalgia and migraine often coexist and can exacerbate one another. Understanding the relationship between these conditions and seeking appropriate medical care can help improve quality of life. If you suspect you have fibromyalgia or are experiencing increased pain, consult with a healthcare provider to explore your treatment options.

This resource is based on HeadWise Episode 171, Fibromyalgia as a Migraine Comorbidity with Vince Martin, MD
Published, 02/02/2024

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