Migraines in Fibromyalgia and CFS/ME
It's rare to come across a person with Fibromyalgia (FM) or CFS/ME, who has never had a
migraine. The serotonin levels in your body are increasing rapidly,
and the blood vessels in your brain have constricted. By the time the pain starts, your
serotonin levels have come back to normal.
But, your blood vessels are now trying to go back to normal, that dreaded pain, starting
on one side of the neck or head. Nothing like that feeling of the after-effects of being
hit upside the head with a baseball bat, and stabbing pain, slowly moving into your eye
socket. Sometimes migraines come with a warning in the form of an "aura," a pattern of
reddish-orange zig-zagging dots, or nausea to the point of vomiting.
Why are migraines so common to FM/CFS/ME? We will take a look at the different types of
migraines, the role Central Sensitization, Magnesium, prodromes and aura's. For many
patients, migraines tend to come with some kind of warning.
The Prodrome Phase
According to the University of Maryland Migraine Headache Intro, "the Prodrome Phase is a
group of vague symptoms that may precede a migraine attack by several hours, or even a day
or two. Prodrome symptoms include:
- sensitivity to light or sound
- changes in appetite, including decreased appetite or food cravings
- fatigue and drowsiness
- mood changes including depression, irritability, or restlessness
An aura can be a visual light disturbance in the form of dots, blind spots, even temporary
loss of sight in on eye. Side effects that are less common include:
- issues with speech as in a stammer or stuttering
- visual spatial distortion
- tremors on one side of the body (migraine seizures)
- feelings of disorientation and confusion
The Postdrome Phrase is the exhausted, drained, hang-over feeling after the migraine.
There are multiple types of migraines that occur, and a person may have more than one
type of migraine, without ever knowing there is a difference.
Types of Migraines
1. Classic Migraines
Usually begin with prodrome warning, like an aura, or visual disturbance, prior to the
onset of pain. Sensory issues can occur, such as a sensitivity to light (photo-phobia,)
a sensitivity to sound (phono-phobia,) and smell (olfactory aura symptoms.)
2. Common Migraines
Usually occur without the warning or aura.
3. Migraine Attack
Is a severe migraine lasting up to 72 hours. The University of Maryland cites the
- throbbing on one half of the head
- pain worsened with physical activity
- nausea and vomiting
- visual symptoms
- facial tingling or numbness
- extreme sensitivity to light and noise
- looking pale and feeling cold
4. Basilar Migraines
Usually start at the base of the skull, or basilar artery. Vertigo is common, ringing in
the ears, slurred speech, and severe pain.
5. Chronic Migraines
Where pain medications are used for 3 or more days, resulting in a rebound effect.
6. Transformed Migraines
Aka chronic severe migraines, can be the result of hormonal issues, thyroid issues,
hypertension, or gastrointestinal related issues.
7. Cluster Migraines
Aka the "alarm clock headache" as patients are usually awoken with a severe headache,
they tend to run in patterns of frequency, and are considered the most painful of
8. Retinol Migraines
Can cause short term loss of sight.
9. Cervical Migraines
Are generated via the cervical spine.
10. Opthalmoplegic Migraines
Are usually felt in the eye, can cause the eyelid to temporarily droop.
11. Hormonal Migraines
Are quite painful can occur just prior to menstruation, during ovulation, and menopause;
the occur with hormonal fluctuations, usually related to estrogen changes. Birth Control
pills and hormone replacement are common triggers of migraines. With Chronic Severe
Migraines, they tend to have several types of migraines. Then there is the role of of
Central Sensitization, meaning an increased sensitivity within the Central Nervous System
is the newest theory on migraines. A published study by Dr. David Dodick and Dr. Stephen
Silberstien, in The Journal of Face and Head Pain found that, "the most recently
articulated theory of migraine is the central sensitization hypothesis, which proposes
that altered processing of sensory input in the brain-stem, principally the trigeminal
nucleus caudalis, could account for many of the temporal and symptomatic features of
migraine, as well as its poor response to triptan therapy when such treatment is initiated
hours after the onset of pain. Both preclinical and clinical data support the central
For many Fibromyalgia patients, Magnesium is one of the four top minerals in the human
body, yet Fibromyalgia patients tend to be Magnesium deficient.
Many migraine patients underestimate the importance of dehydration and Magnesium in
regards to their headaches. Fibromyalgia patients tend to dehydrate easily, so do migraine
patients, and dehydration is a common trigger of migraines. Mark London, a former MIT
student, in his article The Role of Magnesium in Fibromyalgia, he states,
"Magnesium is extremely important to many functions in the body, which is why a deficiency
can cause many different symptoms. It is most widely known for being needed for proper
bone formation. With a deficiency, bones will be soft, and it can play a role in
osteoporosis. However, magnesium is also the activating mineral for at least 350
different enzymes in the body, more than any other mineral, so it is crucial for many of
the metabolic functions in the body."
"Magnesium is necessary for almost all the enzymes that allow the glycolytic and Krebs
cycles to turn the sugar and fat we eat into Adenosine Triphospate (ATP.) Low levels of
ATP have commonly been found in people with fibromyalgia, and it is believed that this
plays an important role in many of the fibromyalgia symptoms".
Thus, a magnesium deficiency would definitely be a factor in worsening those symptoms.
Another study on the effects of Magnesium and migraines by Mauskop A, Altura BM, from the
NW Headache Center, found that "the available evidence suggests that up to 50% of patients
during an acute migraine attack have lowered levels of ionized magnesium. Infusion of
magnesium results in a rapid and sustained relief of an acute migraine in such patients."
Fibromyalgia and CFS/ME pain is also effected by changes in the weather, the same holds
true with migraines.
The weather also plays a factor in migraines, the March of 2009, journal Neurology
stated the risk of migraine goes up 8%, for every nine degree rise in temperature.
Barometric pressure is also a culprit, changes with rain or snow, also cause migraines.
Then,...there are the Migraine Triggers.
The Migraine Triggers
Migraine Triggers are broken down into seven categories by the University of Berkeley;
dietary, sleep, hormonal, environmental, stress, stress let-down, and physical.
Dietary Triggers can be things like MSG, medications, fasting or skipping meals.
Sleep Triggers, too little, too much, or even naps.
Hormonal Triggers involve estrogen fluctuations, birth control and hormonal replacement
Environmental Triggers would include the weather, pollution, altitude (as in air travel).
Stress Triggers would include anxiety, depression, PTSD, panic attacks, and fight or
Stress-Let Down Triggers, would be the body calming after one of the stress triggers,
this actually causes migraines in many people. They will be fine through a crisis, but
once it is over...the pain begins.
Physical Triggers could be overexertion from exercise, spending too much time with work
(or play) involving the eyes, and even fluorescent lights.
While there is a broad nature and cause to migraine headaches, the number of treatments
and pharmaceutical drugs can be even more daunting. In October of 2010, the Food and Drug
Administration finally approved the use of Botox in treating migraines. Non-Steroidal
Anti-Inflammatory Drugs (NSAIDS) still continue to be a primary form of treatment.
However, the drawback in NSAIDS and narcotics, is they both produce rebound migraines.
Other treatments include seizure medications and serotonin inhibitor medications. With the
recent advances in brain imagery scans, science may be closer to developing more effective
treatment and preventative treatment in migraines.