Headache Medicine 2021, 12(4):273-277 p-ISSN 2178-7468, e-ISSN 2763-6178

273

ASAA

DOI: 10.48208/HeadacheMed.2021.44

Headache Medicine

Review

Fibromyalgia in patients with migraine: A literature review in the

last 20 years

Yasmine Maria Leódido Fortes

, Wallyson Pablo de Oliveira Souza

, Raimundo Pereira Silva-Néto

Graduate Program in Biomedical Sciences, Federal University of the Parnaiba Delta, Brazil

Integrated Center of Medical Specialties (CIEM) and Federal University of the Parnaíba Delta, Parnaiba, Brazil

Abstract

Introduction

Possibly bromyalgia and migraine share similar pathophysiological mechanisms, ge-

nerating an imbalance of neurotransmitters involved in pain modulation, with increased

neuronal excitability. The association between these two conditions is frequent, increasing

the disability of both.

Objectives

We aimed to review articles published in the last 20 years about the presence of bromyal-

gia in patients with migraine and to analyze the quality of life of these patients.

Methods

Based on a literature search in the major medical databases and using the descriptors

“migraine” and “bromyalgia” we include articles published between 2001 and 2021.

We found 387 articles, but only ve met the inclusion criteria.

Results

In ve articles analyzed, 429 patients with migraine were found, in which bromyalgia

was present in 31.5% of them, predominantly in women (p<0.0001). In this association,

there was a higher risk for depression and worse quality of life.

Conclusions

The association of bromyalgia in patients with migraine is frequent, increasing the disabili-

ty of these two diseases and generating great social impact. Knowledge of this association

and the management of its consequences are necessary in medical practice.

Yasmine Maria Leódido Fortes

Federal University of the Parnaíba

Delta, Avenida São Sebastião, 2819/

Fátima, Parnaíba, Piauí, 64001-020,

Brazil, Tel. + 55 863221-9000.

E-mail: yasmineleodido@gmail.com

Edited by:

Marcelo Moraes Valença

Keywords:

Migraine

Fibromyalgia

Fibromigraine

Quality of life.

Received: January, 17 2022

Accepted: January, 21 2022

274

ASAA

Fortes YML, Souza WPO, Silva-Néto RP

Fibromyalgia in patients with migraine: A literature review in the last 20 years

Introduction

ibromyalgia is a chronic condition of diffuse musculo-

skeletal pain, accompanied by a series of nonspecic

symptoms, including sleep disturbances and affective dys-

function, in the absence of any objective organic cause.

affects, on average, 2% to 3.6% of the world population.

2-4

Its pathophysiology is not completely known yet. However,

a genetic predisposition was found in the imbalance

of neurotransmitters involved in pain modulation, with

increased neuronal excitability. Clinical expression is

diffusely increased pain sensitivity,

associated with

depression and behavioral abnormalities.

Diagnostic criteria for bromyalgia were established by the

American College of Rheumatology, 1990. It is necessary

the presence of diffuse musculoskeletal pain for at least

three months, and the positivity of at least 11 of the 18

predetermined sites of the body, called tender points.

According to the current criteria, other variables such as

sleep and mood disorders, headache, and visceral pain

must be considered.

1,8

The association of bromyalgia with migraine is frequent,

increasing the incapacity of both.

9-11

Possibly, there is a

common pathophysiological mechanism, with central

nervous system dysfunction, which may benet from the

same treatment.

4,12

It is estimated that the occurrence of bromyalgia in

patients with migraine varies from 22.2% to 45.1%.

4,9,13-15

On the other hand, patients with bromyalgia have a high

prevalence of migraine, around 55.8%.

16,17

The reasons for

this association are still reasons for intense investigation.

Despite its relevance, the association between migraine

and bromyalgia is still poorly studied. There is a scarcity

of studies, despite the high prevalence of this co-morbidity.

Based on this, the authors decided to review the articles on

the association between migraine and bromyalgia that

have been published in the last 20 years.

Methods

This study was an integrative and retrospective review

of the articles on bromyalgia in patients with migraine

published in the last 20 years. The research was performed

in the online databases LiLacs, SciELO and PubMed, from

September to November 2021, using the descriptors

"migraine" and "bromyalgia".

Articles published from 2001 to 2021 that addressed the

discussion of migraine and bromyalgia and written only

in English were included. Editorials, comments, letter to the

editor, articles that were not fully available or those who

lacked accurate information were excluded. To ensure

the validity of these articles, the selected studies were

analyzed in detail regarding the demographic and clinical

characteristics and quality of life of these patients.

Of the 387 articles found, repeated articles or articles that

did not address the relationship between migraine and

bromyalgia were eliminated and only 90 remained and

were analyzed. After reading the abstracts and selecting

those that met the inclusion criteria, ve articles remained

(case series), totaling 429 patients.

Data were analyzed based on demographic and clinical

features. They were presented as an arithmetic mean

with the standard deviation (SD), or as percentages. The

percentage was always related to the total number of

patients whose information was available for the specic

issue. All collected data were organized in a database. The

BioEstat version 5.0 for statistical analysis was used.

Results

A total of 429 patients (68.3% women and 31.7% men)

were diagnosed with migraine and analyzed in this

review, in which bromyalgia comorbidity was present

in 31.5% (135/429) and absent in 68.5% (294/429).

Regarding gender, bromyalgia predominated in women

(p<0.0001), as shown in Table 1.

Table 1. Distribution of 429 migraine patients with and without bromyal-

gia, according to age and sex

Authors,

citation

Migraine patients with FM

(n=135)

Migraine patients without FM

(n=294)

n (%)

Sex

(M/F)

Average age

(years, min-

-max or SD)

n (%)

Sex

(M/F)

Average

age (years,

min-max

or SD)

Küçükşen et al.

37 (31.4) 7/30 37 (20–64) 81 (68.6) 22/59 36 (16–66)

De Tommaso et

al.

23 (45.1) 3/20 40 28 (54.9) 9/19 36

Beyazal et al.

28 (32.6) 1/27 38.6 ± 9.5 58 (67.4) 16/42 33.9 ± 10.3

Onder et al.

31 (30.4) 1/30 36.9 ± 10.0 71 (69.6) 57/14 32.5 ± 9.2

Onder et al.

16 (22.2) 0/16 43.4 ± 11.4 56 (77.8) 20/36 43.6 ± 12.5

Note: FM – bromyalgia

Quality of life in migraine patients with and without bromyalgia

was assessed by MIDAS (Migraine Disability Assessment

Scale), HIT-6 (Headache Impact Test) and FIQ (Fibromyalgia

Impact Questionnaire) scores, as shown in Table 2.

275

ASAA

Fortes YML, Souza WPO, Silva-Néto RP

Fibromyalgia in patients with migraine: A literature review in the last 20 years

Table 2. Quality of life among migraine patients with and without bromy-

algia, according to MIDAS, HIT-6 and FIQ scores

Authors, citation

MIDAS

(mean±SD or range)

HIT-6

(mean±SD or range)

FIQ

(mean ± SD)

Küçükşen et al.

migraine patients without FM 25 (3–110) 62 (42–71)

53.2±12.8migraine patients with FM 26 (4–105) 64 (48–78)

value 0.150 0.003

De Tommaso et al.

migraine patients without FM 38.0±38.95 -

44.53±16.44

migraine patients with FM 71.35±63.9 -

value 0.026 - -

Beyazal et al.

migraine patients without FM 23.3 ± 22.6 58.4±14.5 24.1±11.2

migraine patients with FM 27.6 ± 18.9 62.8±7.1 66.5±10.3

value 0.390 0.481 <0.001

Onder et al.

migraine patients without FM 17.3±25.8 59.9±6.3 -

migraine patients with FM 36.2±40.0 63.3±5.2 -

value 0.002 0.041 -

Ifergane et al.

migraine patients without FM 15.6±21.1 (0–95) 48.4±9.5 (30–66) -

migraine patients with FM 17.8±23.4 (0–90) 49.2±9.9 (30–64) -

value NS NS -

Note: MIDAS – Migraine Disability Assessment Scale; HIT-6 – Headache

Impact Test; FIQ – Fibromyalgia Impact Questionnaire; SD – standard

deviation; FM – bromyalgia.

Discussion

Migraine and bromyalgia are two very prevalent

diseases that affect, respectively, 15%18 and 2% to 3.6%

of the world population. The association between them

is frequent, causing mutual aggravation, making the

diagnosis difcult and inuencing the prognosis.

1,9-11,19

Despite this high degree of co-morbidity, there are still few

epidemiological studies.

Fibromyalgia occurs in patients with migraine, just as

migraine also occurs in patients with bromyalgia,

characterizing a bidirectional association.

10,16,17,21

Therefore, this association was called bromigraine.16

However, in this review, we only investigated the presence

of bromyalgia in migraine patients.

In our review, the occurrence of bromyalgia in migraine

patients ranged from 22.2% to 45.1%.4,9,

13-15

Possibly,

there is a common pathophysiological mechanism, with

central nervous system dysfunction, which may benet

from the same treatment.

4,12,16

These associations may

involve painful conditions at a visceral, musculoskeletal, or

craniofacial level.

In the pathophysiology of migraine, there is a vascular

component mediated by inammatory cytokines and

neuropeptides, including calcitonin gene-related peptide

(CGRP) and substance P and central mechanisms of

hyperexcitability.

On the other hand, there is evidence

of central sensitization in chronic migraine, leading to

decreased pain thresholds against different types of

stimuli at the somatic level.

9,12

These pathophysiological

mechanisms are shared with bromyalgia, in which

generalized musculoskeletal pain activates local

nociceptors transmitting pain impulses through the superior

cervical spinal nerves to the caudal trigeminal nucleus and

inducing a migraine attack.

We found that women with migraine had more

bromyalgia than men (41.2% versus 8.8%). Studies in the

general population have shown that women tend to be

more affected than men, in a ratio of 3:1,

11,23,24

but there is

no evidence for the role of sex hormones in bromyalgia.

However, there are studies suggesting that estrogen and

progesterone exert antinociceptive and anti-inammatory

effects through the regulation of the serotonergic pathway.

In assessing the quality of life of patients with migraine

and bromigraine, we analyzed two scores: Migraine

Disability Assessment Scale (MIDAS) and Headache

Impact Test (HIT-6), both to quantify headache-related

disability,

11,25,26

in which we identied higher scores in

bromigraine.

4,9,14

Fibromyalgia Impact Questionnaire

(FIQ) was used to assess health status, progress, and

outcomes in patients with bromigraine

who received

high scores.

4,13,14

It was found that the impact on the quality of life of patients

with bromigraine is great, with a tendency to have more

intense headache attacks (62.2%

versus

42%, p=0.017), a

greater risk of depression (75%

versus

62%,) and anxiety

(86%

versus

63%).

In addition, patients with bromigraine

have a greater number of medical and psychiatric

comorbidities than those with bromyalgia alone.

Conclusion

The association of bromyalgia in patients with migraine

is frequent, increasing the disability of these two diseases

and generating great social impact. Knowledge of this

association and the management of its consequences are

necessary in medical practice.

Contribution authors: All authors had the same contribution.

276

ASAA

Fortes YML, Souza WPO, Silva-Néto RP

Fibromyalgia in patients with migraine: A literature review in the last 20 years

Funding: No

Conflict of interests: The authors report no conict of

interest.

Yasmine Maria Leódido Fortes

https://orcid.org/0000-0001-9642-0330

Wallyson Pablo de Oliveira Souza

https://orcid.org/0000-0003-3122-9484

Raimundo Pereira Silva-Néto

https://orcid.org/0000-0002-2343-9679

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