Fibromyalgia is a chronic pain syndrome which manifests as chronic widespread pain. The pain is in the muscles and soft tissues, not in the joints. Specific tender points must be present for more than three months before the diagnosis is made.
Fibromyalgis is a central nervous system disorder. The chronic pain is associated with central senisitization, which can make pain processing in the brain occur more easily.
Depression is vey common in fibromyalgia. Between 50% and 70% of fibromyalgia patients have a history of depression. Major depressive episodes occur in 18-36%. Sleep disorders are almost universal in fibromyalgia. Metabolic syndrome is also more common, occurring in five times as many women with fibromyalgia than those without. Elevations in total cholesterol and LDL have been found to be associated with fibromyalgia in women.
Fibromyalgia and Migraine
Estimates of migraine or chronic headache in fibromyalgia range from 30% to over 50%. An epidemiologic study of headache in fibromyalgia was conducted, and 63% of fibromyalgia patients were found to have migraine. Only 8% met criteria for medication overuse headache.
In a study of 92 consecutive migraine patients who were assessed for fibromyalgia, 22.2% of female migraineurs (and none of the men) were found to have fibromyalgia. Migraine severity and characteristics were similar in both those who had fibromyalgia and those who did not.
A questionnaire-based survey, which asked which of several conditions migraine sufferers had been diagnosed with by a doctor, found that musculoskeletal conditions, including fibromyalgia, were increased in migraine sufferers. Migraine with aura sufferers were more likely to to have comorbid conditions than were those who had migraine without aura. Women with migraine were more likely than men to have comorbid conditions.
What is the fibromyalgia-migraine connection?
Hypothalamic neuroendocrine dysfunction has been proposed as a brain mechanism common to both fibromyalgia and migraine. Both conditions also share the mechanism of central sensitization of pain neurons.
While you may read that the transformation of migraine to chronic migraine results in fibromyalgia, this idea has not been borne out in formal studies. In an epidemiologic study, there was no difference in migraine sverity or other migraine characteristics fibromyalgia sufferes with migraine and migraineurs who did not meet diagnostic criteria for fibromyalgia. Not all fibromyalgia sufferers also have migraine. And not all chronic migraine sufferers also have widespread chronic pain.
Many migraine sufferers have a condition called allodynia (also called cutaneous allodynia) during migraine attacks. Allodynia means that a touch that is normally perceived as just that--pressure or touching--is experienced as painful. Usually allodynia is confined to the head and neck, but can involve other areas of the body as well. Allodynia is generally episodic and does not occur all the time, although it can be frequent in chronic migraine sufferers. Allodynia is not the same thing as fibromyalgia.
In some studies, allodynia has been reported in up to 80% of migraineurs during attacks. A recent study of 1413 migraine sufferers found severe cutaneous allodynia to be more likely in those who had two or three comorbid pain conditions (IBS, chrnoic fatigue syndrome, or fibromyalgia).
Fibromyalgia, Migraine, and Other Comorbid Conditions
If you have both fibromyalgia and migraine, you are more likely to also have anxiety and depression. Correlations have also been made between fibromyalgia, migraine, and irritable bowel syndrome.
The association between fibromyalgia and tension-type headache is even stronger than the association with migraine.
1. Ifergane G, Buskila D, Simiseshvely N, Zeev K, Cohen H. Prevalence of fibromyalgia syndrome in migraine patients. Cephalalgia. 2006;26(4):451-456.
2. Le H, Tfelt-Hansen P, Russell MB, et al. Co-morbidity of migraine with somatic disease in a large population-based study. Cephalalgia. 2011;31(1):43 -64.
3. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache. 2010;50(1):42-51.
4. Tietjen GE, Brandes JL, Peterlin BL, et al. Allodynia in migraine: association with comorbid pain conditions. Headache. 2009;49(9):1333-1344.
5. Valença MM, Medeiros FL, Martins HA, Massaud RM, Peres MFP. Neuroendocrine dysfunction in fibromyalgia and migraine. Curr Pain Headache Rep. 2009;13(5):358-364.
6. de Tommaso M, Sardaro M, Serpino C, et al. Fibromyalgia comorbidity in primary headaches. Cephalalgia. 2009;29(4):453-464.
7. Bradley LA. Pathophysiologic mechanisms of fibromyalgia and its related disorders. J Clin Psychiatry. 2008;69 Suppl 2:6-13.
8. Sarchielli P, Di Filippo M, Nardi K, Calabresi P. Sensitization, glutamate, and the link between migraine and fibromyalgia. Curr Pain Headache Rep. 2007;11(5):343-351.
9. Tietjen GE, Herial NA, Hardgrove J, Utley C, White L. Migraine comorbidity constellations. Headache. 2007;47(6):857-865.
10. Cole JA, Rothman K, Cabral H, Zhang Y, Farraye F. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterology. 2006;6(1):26.
11. Sakarya ST, Akyol Y, Bedir A, Canturk F. The relationship between serum antioxidant vitamins, magnesium levels, and clinical parameters in patients with primary fibromyalgia syndrome. Clin Rheumatol. 2011.
12. Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. Migraine and cardiovascular disease. Neurology. 2009;72(21):1864 -1871.
by Christina Peterson, M.D.
updated June 17, 2011