Illness Chronic Fatigue Syndrome And Migraine
Individuals who suffer from Gulf War illness and chronic fatigue syndrome often share many of the same symptoms, including migraine.
Researchers from George Washington University in Washington, D.C. recently suggested that the disorders may share a central nervous system dysfunction that could account for the chronic pain, fatigue, and cognitive dysfunction that Gulf War illness, chronic fatigue, and migraine sufferers have in common.
Migraine is the most common headache disorder among patients with CFS, but more research is needed to determine the type and prevalence of headaches in those who have Gulf War illness, which affects more than 200,000 people who served in the 1990-91 Gulf war. To better understand headache in people with GWI and CFS and potential links between the disorders, researchers, led by Rakib U. Rayhan, MS, studied 50 patients with GWI, 39 with CFS, and 45 controls. As is common with Gulf War illness, all of those in the GWI group fit the criteria for CFS as well.
Eighty-two percent of patients with chronic fatigue also reported migraine symptoms as compared to 64% of those with Gulf War illness and 13% of the control group. Women outnumbered men 4:1 in the CFS group, and more than twice as many men as women were in the GWI group. However, researchers found that gender was not a factor for migraine. Tension headaches were also common in the GWI group , compared to 7% in the CFS group.
Can A Chronic Bppv With A History Of Trauma Be The Trigger Of Symptoms In Vestibular Migraine Myalgic Encephalomyelitis/chronic Fatigue Syndrome And Whiplash Associated Disorders A Retrospective Cohort Study
Abstract:
BACKGROUND: In patients with chronic benign paroxysmal positional vertigo , i.e., chronic vestibular multicanalicular canalithiasis , abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication.
OBJECTIVE: To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome , and whiplash associated disorders .
STUDY DESIGN: Retrospective consecutive observational cohort study.
SETTING: Ambulatory at a private Otoneurology Centre.
PATIENTS: One hundred sixty-three patients with CVMCC and a history of trauma.
INTERVENTION: Based on the symptoms , the patients are post hoc sub grouped according to the criteria of the different diagnoses.
MAIN OUTCOME MEASURE: Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses.
: This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patients dominant symptom.
Find A Doctor Who Will Listen
If you are experiencing fatigue or any other symptom that you find is bothersome and having an unwanted impact on your life I encourage you to make an appointment with your doctor or GP and have a candid discussion with them about what you are experiencing. I fully understand that some doctors will be less than helpful at times or even try to brush off your symptoms, but there are doctors out there who will take your concerns seriously and truly endeavor to find a way to help you address them. This is why finding a qualified doctor or headache specialist is so important to ensure you get the best care for your conditions.
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How Is Chronic Migraine Diagnosed
Your doctor will take a detailed medical history. The doctor will ask about:
- Your pattern of migraine pain, including when and how migraines begin if they are episodic or continuous how long the migraine lasts if there are any triggers or factors that make the migraine worse.
- Your description of the pain, including its location, sensation, and severity.
- Other symptoms that accompany the pain, such as auras, lack of energy, stiff neck, dizziness, changes in vision or in senses, and nausea/vomiting.
- Your current and previously tried treatments, including when the medications are taken, dosages, outcome and side effects and use of alternative or complementary therapies.
- Your medical history including other health problems , family history of headache, current non-headache medications, and lifestyle choices .
Migraine In Gulf War Illness And Chronic Fatigue Syndrome: Prevalence Potential Mechanisms And Evaluation
Abstract:
OBJECTIVE: To assess the prevalence of headache subtypes in Gulf War Illness and Chronic Fatigue Syndrome compared to controls.
BACKGROUND: Approximately, 25% of the military personnel who served in the 1990-1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed.
METHODS: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia , and assessments for exclusionary conditions.
RESULTS: Migraines were detected in 64% of GWI and 82% of CFS subjects compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups = 2.7 P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache.
: Rayhan RU, Ravindran MK, Baraniuk JN. Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation. Front Physiol. 2013 Jul 24 4:181. doi: 10.3389/fphys.2013.00181. ECollection 2013.
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A Symptom Of Migraine And Its Comorbidities
Fatigue is common in many other conditions besides migraine. Some of the more common conditions that have fatigue as a symptom are fibromyalgia, chronic fatigue syndrome, lupus, multiple sclerosis, depression, and sleep apnea. I myself suffer from a couple of these conditions along with migraine disease. Its no wonder why so many of us suffer from fatigue when it is so prevalent with these migraine comorbidities. I am an inquisitive person by nature and I like to read all sorts of studies and research papers on the things that I am experiencing. I recall a study I read on fatigue and it said something like 70% of people that experience headaches have fatigue as a symptom and of those 80% suffer from chronic migraine.
Migraine Another Difficult Disorder To Treat
Acknowledging the frustration physicians face with difficult to treat and understand ME/CFS/GWI and migraine patients, Baraniuk and Rayhan quote Maizels description of the presentation of a typical patient:
..a middle-aged woman with chronic migraine and medication overuse, as well as fibromyalgia. In addition, there is anxiety and depression, fatigue and insomnia, and the familiar exhaustive list of psychotropics and antiepileptic drugs tried and failed
Baraniuk and Rayhan propose that Maizels neurolimbic model which incorporates dysfunctional serotonergic pathways and central sensitization is a good place to approach treating these disorders, and they refer a table produced by Maizel.
Besides the triptans both Baraniuk and Maizels approach to ME/CFS/FM and migraine emphasized stress reduction
Maizels approach is similar to others taken in the field that attempt to tone down central nervous system activity. Other than the use of triptan drugs, his approach relies mostly on behavioral practices to reduce the activation of the neural networks producing the central sensitization, arousal, etc.
- Treat any mood disorders that are present.
- Use CBT, carefully prescribed activity, acupuncture, tai chi and other means to retrain the brain and reduces the stress that triggers migraines/relapses and pain.
- Explore triptan drugs, topiramate. and other migraine therapies in ME/CFS, GWI and FM.
Do You Have Migraines and Not Know it?
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Why Does It Occur With Migraine
When the fatigue occurs after a migraine attack, it is called postdrome.4Postdrome is the group of symptoms that can happen after the actual pain of the migraine attack has gone, but it is still part of the migraine. It can include fatigue, nausea, dizziness, body aches, and trouble concentrating.4
It is not known why postdrome and its symptoms happen.4 The physiological changes that occur during the pain of the migraine itself can persist, which may cause the postdrome.
What Are The Recommended Pharmacological Treatments For Me/cfs
Currently there are no FDA approved treatments for ME/CFS. Rather, treatment focuses on symptom relief. All medications should be taken with instructions from a physician.
- For pain relief, over the counter medications such as NSAIDS may be useful.
- Nerve pain medications such as gabapentin or pregabalin may also be prescribed.
- Blood pressure medications may help with orthostatic intolerance.
- Antidepressants such as tricyclics and SNRIs can be effective for pain in the absence of depression.
- Learning about energy management may help someone with ME/CFS achieve the right balance of activity and rest.
- Cognitive Behavioral Therapy is a shared treatment modality. This type of therapy can help people recognize their thought patterns and help learn ways of coping with stress.
For those that live with both migraine and ME/CFS treatment by a headache specialist or a clinician knowledgeable about headache diseases is critical. Abortive therapies such as triptans, NSAIDS and acetaminophen are often prescribed first. Frequent migraine attacks may require preventive therapy such as propranolol, amitriptyline, topiramate, Botox, CGRP monoclonal antibodies, gepants or vitamins such as magnesium, CoQ10, riboflavin and others. Many migraine preventive therapies overlap with medications that are commonly prescribed for ME/CFS so it is important for your doctors to be aware of all of your diagnoses so the best treatments can be chosen.
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How Is Chronic Fatigue Syndrome Diagnosed
CFS diagnosis depends on two criteria:
A specific treatment for CFS has yet to be proven effective. Vitamin supplements and medicines have some benefit. Many treatments just relieve the symptoms of CFS.
What Are The Symptoms Of Chronic Migraine
Symptoms of episodic migraine and chronic migraine are the same. The difference is simply the increase in frequency of the number of headaches. Typical migraine symptoms include:
- Head pain that is moderate to severe in intensity, worsened by physical activity/movement
- Pain on one or both sides of the head
- Throbbing pain or pressure-like pain
- Sensitivity to light, sound, smells
- Nausea/vomiting
Signs an episodic migraine is transforming to a chronic migraine include:
- Having a growing number of migraine attacks
- Taking more medication because of the growing number of attacks
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Symptoms Of Migraines With Fibromylagia And Me/cfs
Migraines that occur with fibromyalgia or ME/CFS are largely the same as those that occur without. The main difference is that migraines tend to occur more frequently or more severely when fibromyalgia or ME/CFS are involved.
A 2018 study in the Journal of Headache and Pain concluded that people with fibromyalgia have more intense and severe migraine headaches than those without. They are also more likely to experience depression as a result of their migraine.
A similar study in BMC Neurology reported that people with ME/CFS were nearly 17 times more likely to experience migraines compared to people without ME/CFS. Moreover, the symptoms tend to be worse, often with a visual disturbance called an aura. Additional symptoms include poor memory, dizziness, numbness, and heart palpitations.
Based on the current body of research, symptoms of migraine in people with fibromyalgia and ME/CFS frequently include:
- Intense throbbing or aching pain on one or both sides of your head
- Pain that worsens with physical activity
- Nausea or vomiting
Migraines Chronic Fatigue Syndrome And Fibromyalgia: Treatment Options
Two studies suggest as many as 75% of people with chronic fatigue syndrome experience migraines and that most migraines in ME/CFS are undiagnosed. Agreeing that migraines are common in ME/CFS, WebMD, which has very little to say otherwise about chronic fatigue syndrome, states ME/CFS is one of five disorders with high migraine rates.
Consider, as you read the similarities between ME/CFS/FM and migraine below, that Rayhan and Baraniuk propose ME/CFS/FM patients may be in a kind ofchronic migraine-like state.
Studies suggest migraines are very common in chronic fatigue syndrome
Given the long list of migraine symptoms and the considerable overlap with ME/CFS symptoms .the low diagnostic rates may not be surprising.
Besides symptoms and high rates of comorbidity, the relapsing remitting nature of both disorders, the problems with barometric pressure changes, some similar triggers , similar central nervous system abnormalities, etc. make a possible connection between migraine and ME/CFS/FM an intriguing one.
As in chronic fatigue syndrome and fibromyalgia, more women than men have migraines. The disorders share several other commonalities.
Consider that about three times as many women as men get migraines. Consider that both migraines and ME/CFS symptoms are often substantially reduced during pregnancy. Consider that central nervous system hyperactivity plays a role in both conditions, that both feature blood vessel problems and inflammation is a key factor in both.
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Comparative Study Of Anxiety Depression Somatization Functional Disability And Illness Attribution In Adolescents With Chronic Fatigue Or Migraine
Abstract:
OBJECTIVE: To compare adolescents with migraine, unexplained profound chronic fatigue of > 6 months duration, and normal school controls on measures of anxiety, depression, somatization, functional disability, and illness attribution.
METHODS: Adolescents referred to Childrens Hospital and Regional Medical Center for behavioral treatment of migraine or evaluation of chronic fatigue were compared with a group of healthy controls of similar age and sex from a middle school . Subjects completed the Spielberger State-Trait Anxiety Inventory-Trait Form, the Childrens Depression Inventory, the Childhood Somatization Inventory, and estimated the number of school days missed in the past 6 months because of illness. Migraine and fatigued subjects completed an illness attribution questionnaire.
: Adolescents referred to an academic center for evaluation of unexplained chronic fatigue had greater rates of school absenteeism than adolescents with migraine or healthy controls. Those meeting CDC-CFS criteria had higher anxiety scores than controls and higher depression and somatization scores than migraineurs or controls. Parents of adolescents with I-CFS were less likely to endorse psychological factors as possibly contributing to their symptoms than parents of adolescents with CDC-CFS or migraine.
Anterior Cingulate Orbitofrontal And Dorsolateral Prefrontal Cortex As Well As Other Limbic Areas
The involvement of limbic areas on functional brain imaging in pain states is thought to be related to the higher processing of nociceptive input, cumulating the sensory, cognitive, and affective components of pain . The involvement of such areas prior to pain onset in migraine has been more recently shown and suggests that this is not an affective or cognitive consequence of pain and is probably responsible for mediating attentional, mood, and cognitive deficits early in the attack. Some of these areas are part of the default mode network , which has been implicated in the sensory integration, cognitive, and attentional aspects of pain in migraine .
There have been studies demonstrating brain metabolite differences in the ACC of migraineurs compared to healthy controls using magnetic resonance spectroscopy, suggesting altered neurochemistry in this region in migraineurs. It is postulated that this difference may contribute to neuronal hyperexcitability in migraine . Another study has also suggested orbitofrontal cortex hypofunction in migraine, in the context of medication overuse headache, using 18F-FDG positron emission tomography imaging. It was demonstrated that, although most of the pain matrix areas recovered to almost normal metabolism following medication withdrawal from hypometabolism during analgesic overuse, the orbitofrontal cortex remained hypoactive .
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Is Chronic Fatigue Syndrome Me/cfs A Form Of Migraine
by Cort Johnson | Aug 9, 2013 | Brain, Brainstem, Hypoxia, Migraine, Stimuli-hypersensitivity |
This indicates a large unmet need to diagnose and treat migraine in GWI and CFS
Could chronic fatigue syndrome be a form of migraine? That might not be so wacky an idea as it sounds. About ten years ago Puri and Chaudhuri suggested chronic fatigue syndrome was similar to migraine. In the last two years not only have Baraniuks studies indicated high rates of migraine are present in ME/CFS but other studies have found that many people with migraine meet the criteria for ME/CFS.
Are similar central nervous system problems contributing to both migraine and chronic fatigue syndrome?
Finding similar incidences of migraine in Gulf War Syndrome and ME/CFS in their latest study, Baraniuk and Rayhan smushed the two together and then added fibromyalgia to the mix as they proposed GWI, ME/CFS, FM and migraine are kind of like kissing cousins.
Similar patterns of gray and white matter abnormalities and altered brain energetics in GWI, CFS, FM, and migraine suggest that common central mechanisms may contribute to the type of headaches and cognitive impairments perceived as brain fog.
Lets check out more of the migraine/ME/CFS connection.
A Notable Study Regarding The Relationship Between Me/cfs And Migraine
Georgetown University conducted a study to determine the relationship between migraine and ME/CFS.
In this study, one cohort of healthy control subjects and ME/CFS patients:
- completed a history and physical examination
- answered a series of questionnaires
- had an interview to diagnose migraine without aura, migraine with aura or tension type headache
Interviews found that of the 67 ME/CFS subjects 84% had migraine, 81% had tension headaches, compared to 5% and 45% of controls. Additionally, 67% were found to have both migraine and tension headache. Those with ME/CFS experienced higher rates of migraine without aura compared to migraine with aura .
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How Is Chronic Migraine Treated
Treatment of chronic migraine is focused on managing lifestyle choices and headache triggers, managing migraine attacks and providing preventive treatments to reduce migraine attacks.
Lifestyle changes include:
- Beginning treatment for any existing mood disorder or sleep problem.
The typical treatment plan for managing migraine attacks includes:
- Treating migraine attacks early when pain in mild begin with a simple pain killer and slowly increase the dose as needed to the max tolerated dose, unless the headache is severe at the start or will become severe. In such cases add a triptan to the above medication to improve efficacy. Avoid use of opiates if possible. Your doctor will devise a treatment plan to avoid worsening chronic headache by overusing medications.
- Treat associated side effects, such as nausea.
- Consider other treatment techniques, including transcranial magnetic stimulation and transcutaneous supraorbital nerve stimulation.
Preventive treatment is aimed at reducing the number of headaches. Preventive treatments include:
- Beta blockers, such as propranolol , atenolol and metoprolol
- Angiotensin blockers, such as candesartan
- Tricyclic antidepressants, such as nortriptyline , amitriptyline
- Anticonvulsants, such as topiramate , sodium valproate
- Calcitonin gene-related peptide , such as galcanezumab , fremanezumab , erenumab
