Migraines in Fibromyalgia and CFS/ME

February 10, 2012

by Jacynthe Sonne for FM/CFS/ME RESOURCES

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
• thirst
• 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 following symptoms:

• 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 headaches.

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.

Central Sensitization

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 sensitization theory."

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.

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 therapy HRT.


• Environmental Triggers would include the weather, pollution, altitude (as in air travel).


• Stress Triggers would include anxiety, depression, PTSD, panic attacks, and fight or flight.


• 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.