We evaluated the rates of concurrent fibromyalgia and migraine diagnoses at our institution.

Migraine headache and fibromyalgia are both common conditions in the general population, occurring at rates of 12-14% and 3-6% respectively. A recent large epidemiological study reports a high co-occurrence of fibromyalgia and migraine at 30-55%. Co-morbidity of migraine and fibromyalgia has been shown to result in increased generalized somatic hypersensitivity. Migraine headache can promote the development of spontaneous fibromyalgia pain. From our prior research, we know that 67% patients referred to headache clinic have headache misdiagnosis, most commonly chronic migraine and medication overuse. The biggest concern is that chronic migraine with medication overuse, if not addressed, can contribute to worsening fibromyalgia pain and central sensitization.

Based on prior research, there is likely under-diagnosis of comorbid migraine, medication overuse headache and fibromyalgia and vice-versa. We recommend a screen for fibromyalgia and medication overuse in all patients presenting with headache, since comorbidity with other headaches is high and patients often do not spontaneously report symptoms. Medication overuse headache needs to be addressed in patients with comorbid migraine and fibromyalgia in order be more likely to succeed with any other treatments.