Comorbid fibromyalgia for people with migraine is often an unpleasant reality. In fact, many studies indicate that 20-36% of people with migraine also have fibromyalgia, a painful, chronic disease affecting the muscles, joints, and bones. A recent study found a two-way (bi-directional) association between the onset of fibromyalgia and migraine disease, and vice versa. However, it’s not always known or understood which disease came first. To date, no explanations have been provided for the rate of co-occurrence.
The primary symptoms of fibromyalgia include widespread pain, fatigue, headache, and cognitive impairment. Fibromyalgia can be comorbid with other conditions, such as anxiety and depression, irritable bowel syndrome, chronic fatigue syndrome, interstitial cystitis, temporomandibular joint disorders, and postural tachycardia syndrome. However, one of the most profound fibromyalgia comorbidities is migraine. A large study found a 55.8% prevalence of migraine among fibromyalgia patients. Yet another study put that number at 45-80%. The condition overwhelmingly affects women—a whopping 80-90% of the time.
People with both migraine and fibromyalgia have abnormal levels of serotonin and norepinephrine—two neurotransmitters that regulate mood. A deficit can cause anxiety and depression, and it’s been found that fibromyalgia worsens pain and depression in people with migraine. This is not surprising given that both conditions are comorbid with anxiety and depression, associated with lower neurotransmitter levels.
Unfortunately, there are no definitive tests for migraine and only one, expensive, new test for fibromyalgia  – a test that many healthcare professionals remain skeptical and which is not covered by all insurance plans, leaving many patients with an unclear diagnosis and treatment path. As a result of all the comorbidities, widespread misunderstanding, and the lack of definitive and available tests, people who live with both migraine and fibromyalgia tend to face a formidable, often debilitating foe. Misguided attitudes that downplay the severity or even deny existence of these comorbid conditions can be beyond discouraging for people dealing with them. Anyone who lives with these disorders can attest that the struggle is all too real both in the healthcare system and society in general. Read more about medical gaslighting here.
If you or your physician suspect you have fibromyalgia in addition to migraine, it is important to seek specialized help. While headache specialists are best for treating migraine, fibromyalgia can be more complicated with patients often being referred to a variety of specialists including rheumatologists, neurologists, pain specialists, and more. You may also want to seek psychological support to deal with the anxiety and/or depression that can accompany fibromyalgia, especially given its impact together with migraine.
Tricyclic antidepressants are often used as the first line treatment for fibromyalgia, and are also a standard treatment for migraine prevention. However, there are many other therapies helpful in treating the overlapping symptoms including a variety of both prescription medications and non-pharmaceutical options. Cognitive behavior therapy can often help, as can biofeedback, mindfulness, and even massage therapy. You and your physician will likely have to experiment to find the right combination of treatments to effectively treat both diseases, and for some people it can be a long journey to find something that really makes a difference.
Last, but not least, self-care is extremely important when dealing with migraine and fibromyalgia. It’s crucial to:
- Get regular sleep
- Do regular, gentle exercise
- Monitor your diet and stay hydrated
- Employ stress management techniques
- Connect with migraine and fibromyalgia communities to learn and share with others who truly understand your pain
Tell us! Do you live with comorbid migraine and fibromyalgia? What has and hasn’t worked for you? What other advice do have for others dealing with these comorbid diseases?