Headaches and Migraines in Fibromyalgia, ME/CFS

Headaches and migraines are common in people with fibromyalgia and chronic fatigue syndrome, also known as myalgic encephalomelite (ME/CFS). In fact, headaches of a new type, pattern, or severity are one of the diagnostic criteria for ME/CFS.Inasmuch asSometimes headaches are treated as a symptom of these conditions, while sometimes they are considered a comorbid condition.

Here’s an overview of how these three conditions relate, as well as how you can treat and manage them.

How they are connected

Fibromyalgia and ME/CFS belong to a group of diseases that have been labeled with several different umbrella terms, including functional somatic syndromes and somatic diseases. Another term that has gained prominence in recent years is central sensitivity syndromes. These syndromes are defined as illnesses with physical symptoms that cannot be fully explained or diagnosed as an established medical condition.

Migraine has long been associated with functional somatic syndromes, including ME/CFS and fibromyalgia, meaning the conditions often occur together. Although it’s still unclear why this happens, researchers are investigating the possibility that one of the underlying mechanisms that the three conditions may share is central sensitization.Inasmuch asInasmuch as

Artwork by Cindy Chung, Verywell

Central sensitization is associated with a number of diseases, including mental health disorders, and occurs after repeated exposure to certain stimuli such as touch, noise, light, temperature, scent, and chemicals.Inasmuch asGradually, your central nervous system becomes abnormally oversensitive to a stimulus or stimuli (the culprits may vary from person to person), intensifying your pain.

Scientists are still trying to figure out exactly what causes central sensitization, but it seems to have both a biological and a psychosocial basis.Inasmuch asThe assumptions so far include:

  • Inflammation
  • Dysregulation of central nervous system pathways
  • A dysfunctional stress response system, particularly in the hypothalamic-pituitary-adrenal (HPA) axis
  • Dysregulation of the autonomic nervous system, which controls automatic functions such as breathing, heart rate, and digestion
  • Changes in the way the brainstem processes stimuli

A manifestation of central sensitization is called allodynia, a type of pain that occurs in response to a stimulus that would not normally cause pain, usually touch. Allodynia is associated with migraine, fibromyalgia, and sometimes ME/CFS.Inasmuch asInasmuch as

It will be interesting to see what future research reveals about the link between migraine, fibromyalgia, and chronic fatigue syndrome, particularly with respect to central sensitization.

Treat headaches and migraines

Since fibromyalgia and ME/CFS treatment involves managing your symptoms, controlling your head pain is crucial. Types of headaches that may be present in fibromyalgia and ME/CFS include tension headaches and migraines.Inasmuch asFortunately, there is a wide range of options when it comes to treatment.

Over-the-counter medications

Over-the-counter medications for the treatment of headaches and migraines include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen), Aleve (naproxen), and aspirin
  • Pain relievers like Tylenol (acetaminophen) and Excedrin (aspirin/paracetamol/caffeine)

Of these, Tylenol may be the least effective for severe headaches.

Prescription drugs

Health care providers sometimes prescribe migraine medications when over-the-counter medications aren’t enough. These drugs include:

  • Prescription pain relievers such as Cambia (diclofenac) and stronger formulations of ibuprofen or acetaminophen
  • Triptans like Imitrex (sumatriptan), Axert (almotriptan), Relpax (eletriptan), Maxalt (rizatriptan), and Zomig (zolmitriptan)
  • Migranal (dihydroergotamine), an ergot alkaloid
  • Antiemetics such as chlorpromazine, Haldol (haloperidol), and metoclopramide
  • Corticosteroids

Prevent headaches and migraines

More important than treating headaches when you have them is preventing them from happening, especially because minimizing headaches can also help reduce your fibromyalgia and ME/CFS symptoms.


Medications your health care provider may prescribe to help reduce the frequency of your migraines include:

  • Biologics, such as Aimovig (erenumab) and Ajovy (fremanezumab-vfrm)
  • Beta-blockers like Inderal (propranolol), Toprol (metoprolol), and timolol
  • Antidepressants, such as amitriptyline
  • Anticonvulsants like Neurontin (gabapentin), Depakote (divalproex), and Topamax (topiramate)

Some of these abortive and preventative drugs are also used to treat symptoms of fibromyalgia and chronic fatigue syndrome,Inasmuch astherefore one treatment can help several conditions. That said, it’s important to remember that no single treatment is likely to relieve all of your symptoms when trying to treat more than one condition.

When taking multiple medications, it is important to talk to your healthcare provider and/or pharmacist about possible side effects and drug interactions.

Non-pharmacological measures

Beyond preventative medications, some other measures that can help prevent headaches and migraines include:

As with medications, some of these treatments can also help relieve symptoms of fibromyalgia and ME/CFS.

Lifestyle changes

Lifestyle changes can also play an important role in your migraine-fibromyalgia-ME/CFS treatment, including:

  • Diet changes: You may find that certain foods or drinks trigger your headaches, which makes avoiding them important for how you feel.
  • Exercise: While exercise helps some people, it’s tricky when you have fibromyalgia or, especially, ME/CFS. Make sure you don’t make yourself worse by overdoing it.
  • Stress reduction: Learning to manage and reduce your stress can also help, especially since stress is a major trigger for headaches and migraines.

A word from Verywell

Managing one condition tends to be difficult, and having multiple conditions can complicate things. Working to actively treat and manage all of your conditions, and generally lead a healthy life, can make a noticeable difference in your quality of life. Fortunately, in the case of migraine, fibromyalgia and ME/CFS, several treatments and preventive measures can allow you to obtain a double action. If you have problems with headaches or migraines, talk to your health care provider so you can get a diagnosis and start looking for effective treatments.

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