What You Need to Know About Migraine and Fibromyalgia
Why do people with migraine have a higher risk of fibromyalgia, and vice versa? Here are answers to some common questions.
If you’re living with migraine and fibromyalgia, you may wonder what is going on in your body that could be causing these painful conditions — and whether there’s a connection between the two.
In fact, there is a connection, or what’s called a bidirectional relationship, meaning that if you have one condition you are more likely to also have the other.
Learn more about how these two conditions are related, as well as what treatment options exist for symptoms that can occur in both migraine and fibromyalgia.
Studies show a strong association between migraine and fibromyalgia.
People with migraine are more likely to also have fibromyalgia, and people with fibromyalgia are more likely to also have migraine, compared with how common each condition is on its own in the general population.
Both conditions are also more likely to occur, and co-occur, in women than in men.
“These conditions share overlapping mechanisms that involve how the brain processes pain,” says Daniel Arkfeld, MD, a rheumatologist at Keck School Medicine of USC in Los Angeles. “There is a growing body of research suggesting that both conditions stem from central sensitization — a heightened response of the nervous system to pain signals.”
Does One Cause the Other?
While there’s no definitive evidence that migraine causes fibromyalgia or vice versa, researchers believe that they may share common pathways that increase vulnerability to chronic pain.
“One theory is that repeated migraine attacks might change how the nervous system responds to pain over time, potentially triggering fibromyalgia in people who are already predisposed,” says Dawn Buse, PhD, a clinical professor of neurology at Albert Einstein College of Medicine in New York City. “On the flip side, early fibromyalgia symptoms — such as pain and stiffness in the neck and shoulders — might activate nerve pathways and contribute to the onset of migraine.”
Further studies are needed to fully understand the bidirectional relationship, but the physiological overlap — especially involving neurotransmitters like serotonin — suggests a shared biological basis.
Symptoms common to both migraine and fibromyalgia include:
Chronic headaches: People with fibromyalgia often report headaches. And migraine can cause different types of headache pain. One study found that migraine patients with a higher headache frequency had a greater risk of fibromyalgia.
Sensitivity to light, sound, and smells: Common in migraine, these sensory sensitivities are also frequently reported by people with fibromyalgia.
Fatigue and cognitive difficulties: Often referred to as “fibro fog,” issues with concentration and memory occur in both conditions.
Sleep disturbances: Trouble falling or staying asleep can exacerbate pain and make symptoms worse across both conditions.
Gastrointestinal issues: Many people with fibromyalgia and migraine experience gastrointestinal symptoms such as nausea and vomiting.
Depression: Symptoms of depression are more likely to occur in people who have both migraine and fibromyalgia.
Typically, having fibromyalgia makes migraine more severe, says Roderick Spears, MD, chief of the headache division at Brown University in Providence, Rhode Island. “When deciding on a medication or therapy, we try to choose one that will address both disorders,” he says.
Medications
Medications that can address both fibromyalgia and migraine include:
Antidepressants:Serotonin and norepinephrine reuptake inhibitors such as duloxetine (Cymbalta) and venlafaxine (Effexor) may help reduce pain sensitivity and prevent migraine attacks. The tricyclic antidepressant amitriptyline may also be used.
Anti-seizure drugs: Medications such as pregabalin (Lyrica) and gabapentin (Neurontin) are approved for fibromyalgia and are sometimes prescribed to prevent migraine.
Behavioral Therapies
Certain behavioral approaches can address both migraine and fibromyalgia, such as:
Cognitive behavioral therapy:Cognitive behavioral therapy aims to change the way people think about difficult or stressful situations, so that they can respond to these challenges in a more positive and productive way.
Mindfulness and meditation: Research has shown that mindfulness-based stress reduction, which is a form of meditation, can significantly decrease pain severity in people with chronic pain conditions.
Biofeedback and acceptance and commitment therapy (ACT): These approaches help improve pain coping mechanisms by enhancing body awareness and emotional regulation. Research published in 2023 found that ACT improved pain, depression, and fatigue in people with fibromyalgia.
“Behavioral therapies give people tools to respond differently to stress, which is a common trigger for both conditions,” says Dr. Buse.
Lifestyle Changes
A few lifestyle adjustments can make a meaningful difference in managing both migraine and fibromyalgia, says Dr. Spears.
Prioritize quality sleep: Poor sleep is linked to worse outcomes in both conditions. A study published in 2024 found a strong correlation between chronic pain conditions and sleep quality.
Eat a balanced diet: Limit processed foods, caffeine, and artificial sweeteners, all of which can be migraine triggers for some.
Stay hydrated: Dehydration can trigger migraines and worsen fatigue.
Exercise when possible: Gentle movement, such as walking, swimming, or stretching, may reduce stiffness and enhance well-being, though it’s important to start slow and modify as needed. “Some people with fibromyalgia can’t exercise because of physical pain, and some people with migraine can’t exercise because it triggers more migraine headache. However, I do think activity can benefit those individuals who can tolerate it,” says Spears.
People with migraine often also have fibromyalgia, and vice versa.
While no one knows for sure why there is a connection, some researchers think the two conditions share common pathways that make a person vulnerable to pain.
Headaches, sleep disturbances, and depression are among the symptoms common to both migraine and fibromyalgia.
Both conditions can be treated with medications, behavioral modifications, and lifestyle changes.
