FAQ Episode 49: Fibromyalgia and migraine: are there common elements in origin and treatment?

Frequently Asked Questions about Natural Migraine Relief

You’re most likely reading this because you have a personal connection to migraine headaches. This post will look at another common and poorly understood problem called fibromyalgia and compare potential root causes and potential non-drug therapies to those of migraine headaches.

Fibromyalgia is a difficult to define disorder with a symptom complex that can include:

• musculoskeletal pain in multiple locations along with muscle and joint stiffness. This discomfort is often described as burning, aching, or throbbing.

• an overwhelming sense of fatigue.

• sleep disruption.

• problems concentrating, thinking clearly, and with memory and recall.

• an increased sensitivity to light, noise, odors, and temperature.

• digestive dysfunction like bloating, irritible bowel and constipation.

It is thought that the fibromyalgia condition amplifies painful sensations by affecting the way your brain and spinal cord process painful vs. nonpainful signals. Sounds a bit like migraines headaches, doesn’t it?

Fibromyalgia affects three to four percent of the population, around five million people in the U.S. In a manner even more impressive than migraine, it affects women more often than men, in this case by an 8:1 ratio. It is the most common cause of generalized musculoskeletal pain in women between the ages of 20 and 55, and is most commonly diagnosed in one’s 30s-40s. At times, symptoms begin after a provocative event, such as physical or psychological trauma. In other cases, symptoms seem to gradually accumulate over time without a single triggering event. As the symptom complex suggests, it is hard to pin down precisely. This may explain why the typical time lag to diagnose it is in the three to six year range.

Let’s compare these two disorders with some correlations I’ve noticed in my medical practice over the years, which is that both migraine and fibromyalgia:

• are far more common in women than men, as noted above.

• typically make their appearance during the reproductive years and are often clearly affected by hormonal deficit or imbalance.

• have a disturbance of pain and pain perception as a key symptom.

• tend to have sleep disruption as either a result of the problem or as a promoting factor and more often, both.

While these are not comprehensive root cause components, they do suggest common elements where we can apply non-drug therapy measures.

Overlapping therapy elements in Fibro and Migraine

Each of these disorders has an extensive literature devoted to diagnosis and “curative therapy.” I’m not going to replicate that in this post, but will briefly address five areas of perpetuating factors and potential interventions that these two problems have in common:

Quality of sleep

Its pretty safe to say that the average women with either fibromyalgia, migraine, or worse yet…both, has a problem getting quality sleep. One reason that women have more fibro and migraine, and associated sleep problems is hormonally based. For instance, if you have heat exchange problems related to declining estrogen, you can be robbed of the deep restorative sleep that “charges your batteries” for mental, emotional and physical energy the next day. If you don’t renew neurotransmitter levels overnight, the brain is more susceptible to pain perception. If you experience a heat exchange problem (hot flashes, night sweats) you may benefit from bio-identical estrogen support. This can also apply to those still having periods and some estrogen support at the end of your cycle can be helpful.

Progesterone deficits can also be a factor in brain chemistry, and this can occur throughout the ovarian life cycle, sometimes starting as early as the teen years with onset of menses. No doubt some reading this will remember how their migraines started around the first year they had a period.

Progesterone calms the brain, and I’ve found that nighttime oral dosing can assist in falling asleep, as well as, achieving deeper sleep cycles. I would consult a bio-identical knowledgeble practitioner on how this would work best for you. (subscribers see Lesson 24: Getting another opinion: finding an integrative or functional medicine minded practitioner.)

Thyroid hormones

These are the ‘spark plugs’ for every cell in the body, and when they are at suboptimal levels, cells under perform their vital functions, which produces fatigue and low-grade cellular dysfunction. A review of typical low thyroid symptoms looks like a neurotic’s checklist…a little of this, a little of that, but usually not enough to be glaringly obvious, or to kill you…right away. Here’s a sample of low thyroid symptoms:

• sensitive to cold, or being cold

• constantly fatigued, even exhausted

• unable to respond to exercise, or to lose weight

• frequently constipated

• hair or skin is dry

• depression

• muscle aches or muscle weakness

• a loss of sexual libido

• new or worsening headaches

• tingling in the extremities

• an irregularity in your periods or having heavy periods

One of the first things I do when I see someone that I suspect for fibromyalgia or migraines is to check their thyroid levels, and consider support therapy to aim for the upper half or third of the normal range. We don’t know what your “normal” is, and many doctors are fine if its in the general ‘normal range,’ even if just barely. Sometimes we need a ‘test drive’ of two to three months of individualized thyroid support therapy to find out if a better version of normal helps you to join the “I didn’t know how bad I was until I got better” club. Get an evaluation of your TSH, Free T4 and Free T3 levels, either with your personal physician, or even direct-to-consumer at a lab like www.lifeextension.com For more information about the role of thyroid in migraine (which applies to fibro as well) see my Natural Migraine Relief Lesson 15: Hormone Root Cause factors in Migraine: Thyroid gland. If you are not a current NMR course subscriber, see sign up info below.

Reproductive hormones

I’ve briefly reviewed the role of estrogen and progesterone, but would like to add one more key reproductive hormone to our discussion, which is testosterone. Testosterone is not a woman’s dominant hormone, but can play a supporting role related to fibromyagia and migraine. Testosterone is well known for its muscle and connective tissue reparative benefits as well as brain chemistry interactions. If you are in your 30s-plus age range, consider checking your Free Testosterone levels. I commonly find that women with both fibro and migraine run at or below the lowest acceptable levels, and that aiming support at the mid-range healthy testosterone level (like a 2-3 ng/dl level of Free Testosterone) can lessen symptoms of both of these problems, as well as, reducing fatigue, alleviating low grade depression, assisting exercise response along with associated weight loss and improved sexual libido. You will need a knowledgeble M.D./D.O. to assist you with this.

Adrenal hormones

As you can see from the flowchart below, your adrenal hormones are a palette of interconnected compounds with a variety of functions. You might note that up at the top left, your cholesterol is the structural platform from which are all made. If your cholesterol is elevated, that could be a sign that you are trying to compensate for either underproduction, or overuse of these hormones. This can happen with chronic stress, and also during the perimenopausal years when the adrenal works to compensate for declining ovarian output. Notice in the flow chart below how the precursor to all of these hormones is cholesterol.

If you are under aggressive therapy to lower cholesterol, beware of letting your total cholesterol be driven below ~150, as you need this structural precursor for :

• Cell membranes. Cholesterol is a key component of every cell membrane.

• Hormone production. Cholesterol is the precursor molecule for the synthesis of many hormones, including sex hormones like estrogen and testosterone, and steroid hormones like cortisol and aldosterone.

• Vitamin D. Cholesterol is essential for the body to produce Vitamin D.

• Bile acids. Cholesterol is a constituent of bile salts, which help the body digest fat and absorb the fat soluble Vitamins A, D, E, and K.

There are several ways to assess adrenal function, one of which is to measure:

• Pregnenelone and DHEA levels as a proxy for adrenal output.

• Cortisol levels. This is usually measured at 8 AM and 4 PM of a typical day, as cortisol starts the day higher and drops over the following 12 hours. We look for either adrenal stress (higher levels AM and PM) indicating overproduction as a response to stress, or adrenal fatigue (low levels AM and PM) as a sign of adrenal inability to produce its downstream components.

• You can also find all of the adrenal metabolites listed in the graphic above on dried urine tests which measure the various metabolites for a better look “inside the box” at how the adrenals are coping. The version I use the most is the DUTCH (dried urine test for comprehensive hormones) by Precision Analytical, found at dutchtest.com. You do need an affiliated practitioner to order it for you. Check out their site for this info, as well as, lots of related educational papers and webinars.

• The specifics of adrenal support usually require individualized attention. My course chapter for paid subscribers Lesson 17: Hormone Root Cause factors in Migraine: Adrenal gland has much more detailed information.

Correction of adrenal deficits can be helpful if not essential for recovery from either migraine or fibromyalgia. It should be monitored, however, as it can affect levels of reproductive hormomes. An integrative physician who understands individualized hormone replacement would be a good partner for this. Paid subscribers can find more on doing this in Lesson 24: Getting another opinion: finding an integrative or functional medicine minded practitioner.

Dysbiosis

Those with migraine and/or fibromyalgia can also share the common associated condition called dysbiosis. If your gut microflora, with the ~12 trillion bacteria in our bowel along with the microclimate they produce are not in balance, you can:

• fail to digest or absorb food well, leading to micronutrient deficits

• maldigest some food contents into byproducts that directly irritate the bowel lining, or feed counterproductive bacterial subpopulations to overgrow their boundary limits.

• have bowel motility problems that can produce diarrhea, constipation or variations of both. This general condition is often termed “irritible bowel syndrome.” This can promote both fermentation based maldigestion, as well as, nutrient deficits.

• end up with a condition loosely termed “leaky gut syndrome,” where partially digested food and bacterial endotoxins can pass through the barrier between the gut lumen and the bloodstream. About 70% of your entire immune defense system lines the GI tract, which tells you what a critical port of entry this is. If the gut lining allows foreign antigens or toxins through, it activates an immune response. Fibromyalgia and migraine are only two of many disorders where immune mediated inflammation in the gut can cause dysfunction far from the GI site of origin. Many if not most autoimmune disorders can have dysbiosis and a leaky gut as a promoting factor which can then trigger genetic predispositions.

Some strategies for management of dysbiosis:

• Dietary avoidance of direct toxins to the GI tract lining. Consider washing pesticides off fruit, avoiding more than two alcoholic drinks per day, and minimizing processed and gluten based carbs that have higher levels of herbicides, like glyphosate.

• Taking a range of beneficial bacteria (probiotics) along with the non-digestible fiber (prebiotics) to feed them.

• Consider testing for food sensitivity with blood IgG levels. If you are eating foods to which your gut and immune system have made IgG antibodies (not the IgE antibodies of more severe anaphylactic reactions,) you may be unnecesarily provoking local GI and even body wide inflammation.

• You may also benefit from stool testing to identify pathogenic bacteria and any evidence of a maldigestion process. If you have evidence of candida overgrowth, you may benefit from either herbal or prescription antifungal therapy.

That’s a lot of information, I know! If you have fibromyalgia or migraine, I don’t know how much of this information your current physicians may have reviewed with you. Since you are reading this, its likely less than what you need. If you see elements of your health history in what we’ve discussed, I would consider doing further research of your own. My course Natural Migraine Relief for Women is an useful and inexpensive place to start. You may also want to find a local integrative minded physician or mid-level practitioner who can direct a more specific and individualized plan for you.

However you choose to move along this path, keep moving! It would be nice if we had a one-off solution to these two difficult medical disorders, but we don’t. When you identify the underlying root cause factors that add up to produce the clinical symptoms you suffer, you begin the process of healing, and of compensating for the genetic or situational factors that allowed it to happen to you.

I aim to produce this ongoing blog to push you forward on that journey, so please check in with me here from time to time for ideas and options about Natural Migraine Relief.