Fibromyalgia Tied to Chronic Migraines

The frequency of fibromyalgia is significantly higher among patients who have chronic migraine headaches than in patients who have chronic tension-type headaches, and patients with chronic migraines experience more severe symptoms of fibromyalgia.

Patients with chronic migraine headaches and fibromyalgia have significantly more anxiety, depression, and insomnia than those with chronic migraine headaches alone.

Soo-Jin Cho and fellow researchers in South Korea pointed out that both fibromyalgia and chronic migraine headaches are relatively rare in the general population such that a link between them may suggest a common pathophysiological mechanism.

Recent updates to diagnostic criteria for chronic migraines have made it easier to distinguish between these headaches and chronic tension-type headaches, allowing researchers to better examine the prevalence of fibromyalgia among patients who have chronic migraines.

The authors sought to determine the symptoms of fibromyalgia among patients with chronic migraine and tension-type headaches, the frequency of fibromyalgia with both types of headaches, and the clinical presentation of both types of headaches among those with fibromyalgia. They presented their findings in a recent Headache article.

The study
The authors conducted a multicenter, prospective, cross-sectional study that looked at 171 patients with headaches, 136 with chronic migraine and 35 with chronic tension-type headaches.

The results
• Subjects with chronic migraine experienced more frequent severe headaches (98.5% versus 80.0%, P < .001) and anxiety (77.2% versus 51.4%, P= 0.002) when compared with those who had chronic tension-type headaches.

• There was no significant difference between the headache groups with regard to the frequency of medication overuse headaches or restless leg syndrome.

• Feeling pain in at least 1 of 19 bodily areas in the prior week was reported by 98.2% of subjects.

• Fatigue, waking unrefreshed, and cognitive and somatic symptoms were overwhelmingly common in study subjects.
• Widespread pain indices were significantly higher in patients with chronic migraine headaches when compared with those with chronic tension-type headaches (8.6 +/- 4.7 versus 4.0 +/- 2.6, P < .001).

• Symptom severity scores were significantly higher in subjects with chronic migraines than in those with chronic tension-type headaches (7.5+/- 2.1 versus 6.2 +/- 2.1, P=0.015).

• Somatic symptoms were significantly more frequent in subjects with chronic migraines than in patients with chronic tension-type headaches (2.4 +/- 0.8 versus 1.5 +/- 0.7, P < .001).

• Significantly more patients with chronic migraine headaches were diagnosed with fibromyalgia when compared with those with chronic tension-type headaches (66.9% versus 25.7%, P < .001).

• Scores on the Fibromyalgia Impact Questionnaire were significantly higher in subjects with fibromyalgia and chronic migraine headaches when compared with subjects who had fibromyalgia with tension-type headaches (58.2 +/- 10.6 versus 46.7 +/- 12.9, P =0.003).

• Subjects with chronic migraine headaches and fibromyalgia had significantly more photophobia, phonophobia, anxiety, depression, and insomnia than those with migraine headaches alone.

Implications for physicians
• Fibromyalgia is very common in patients who have chronic headaches and, in particular, those with migraine-type headaches.

• Physicians should screen for symptoms of fibromyalgia in patients with chronic migraine headaches and vice versa.

• Common serious comorbidities, such as depression and anxiety, as well as somatic symptoms should be assessed in patients with chronic migraine headaches.

• Fibromyalgia symptoms may be significantly worse in patients who have migraine headaches.

References:

Cho SJ, Sohn JH, Seok Bae JS, Chu MK. “Fibromyalgia Among Patients With Chronic Migraine and Chronic Tension-Type Headache: A Multicenter Prospective Cross-Sectional Study.” Headache. 2017 Nov;57(10):1583-1592. doi: 10.1111/head.13191. Epub 2017 Sep 22.