Fibromyalgia and Chronic Headache

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Reprinted with permission from ACHE (American Council for Headache Education), Mt. Royal, New Jersey, USA
 

Fibromyalgia is a common chronic pain syndrome, affecting an estimated 3 to 9 million adults in the United States. Fibromyalgia is not a specific disease. The term fibromyalgia describes a pattern of symptoms that cluster together, including widespread body pain and sensitivity to pressure on specific spots on the body, called tender points. Curiously, these particular tender points are uniquely sensitive to pressure in people with fibromyalgia, while similar spots in other parts of their bodies are not. In addition, people with other types of chronic pain, such as low back pain or arthritis, do not find that pressing these spots is painful for them.

Until 1990, fibromyalgia was used to describe a variety of unrelated chronically painful conditions. In 1990, the American College of Rheumatology established specific diagnostic criteria, allowing proper identification of those patients with fibromyalgia. Patients with fibromyalgia must have pain on both sides of the body, as well as areas of the body both above and below the waist. In addition, fibromyalgia patients perceive firm pressure over the tender points to be painful. Patients with fibromyalgia experience a variety of other symptoms in addition to body pain. As you can see, the majority of fibromyalgia patients also report fatigue, morning stiffness, sleep disturbance, and abnormal body sensations or tingling. Over half report some headache.

Patients with fibromyalgia share many features with chronic headache patients. Similar to migraine, fibromyalgia occurs most commonly in women of childbearing age, with women affected 7 times more often than men. Fibromyalgia and chronic headache commonly occur together. A study of about 100 patients with transformed migraine showed fibromyalgia in 36% of the migraine sufferers. Those patients with both fibromyalgia and headaches experienced both greater pain severity and more depression. Another study compared about 70 patients with fibromyalgia to those with chronic headache. About 35% of the fibromyalgia patients reported migraine or tension-type headache, while 42% of the headache patients had painful fibromyalgia tender points throughout their bodies. Similar to the other study, patients with both fibromyalgia and headache reported more pain, disability, and depression than patients with headache alone. This general sensitivity to touch over the tender points, noted in about 40% of chronic headache sufferers, suggested the presence of nervous system activation or sensitization. In other words, 40% of chronic headache patients report hypersensitivity throughout the body (in addition to the head), similar to fibromyalgia patients.

These studies suggest that fibromyalgia, like some types of chronic headache, may be associated with increased excitation within the nervous system, which means it over-responds to stimulation that is not normally painful. (See "Central Sensitization: A New Theory of Migraine" in the Fall 2002 issue of the newsletter.) Similar to migraine, abnormalities in serotonin, a brain chemical involved in fine-tuning painful experiences, may be contributing to the increased excitation in fibromyalgia. Also, levels of substance P, a brain chemical that is involved in pain sensation, are high in patients with fibromyalgia. Finally, patients with fibromyalgia and patients with chronic headaches respond in similar ways to stress, and differently from people who do not have fibromyalgia or frequent headaches.

The cause or causes of fibromyalgia are still unknown. Some patients develop fibromyalgia symptoms after trauma or illness, while others develop the condition without any identified triggering event. Fortunately, fibromyalgia is not a degenerative or progressive disorder that would develop into paralysis, memory loss, or other losses of functioning.

Interestingly, a number of headache therapies are also effective in reducing symptoms of fibromyalgia:

Antidepressants (which have pain-relieving effects)

Tizanidine (a muscle relaxant with pain-relieving effects)

Psyschological pain management skills (for example, stress management, coping skills, relaxation training)

Aerobic exercise

As with chronic headache, education about fibromyalgia and pain management is helpful in managing symptoms and limiting their impact on daily life.

Patients with both fibromyalgia and chronic headache should initially try those therapies that may effectively treat both conditions. Standard headache acute care and preventive therapies should be used when headache persists after completing fibromyalgia treatment, or if headache becomes the main pain complaint.

If you are experiencing widespread body pain, it is important to discuss this with your doctors.

Fibromyalgia patients are at increased risk for depression and anxiety, and report more interference and disability from their pain than patients with headache without body pain. Failure to recogize and treat co-existing fibromyalgia may result in increased pain, disability, depression, and anxiety. In addition, effective therapies are available for fibromyalgia that can significantly improve headache in addition to treating the generalized body pain.

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Published on the Help For Headaches Web Site

http://www.headache-help.org

The opioids (narcotics) cause progression of the illness (Chronic Daily Headache), not termination, and will actually make the individual much worse over time. It is easier and quicker to give the patient a pain killer than to "get into the trench" and try solve the problem. Patients with chronic daily headache require time, diligence, and frequent access from their physician.

Interview: Dr. Joel Saper, MHNI
-from the book Chronic Daily Headache

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