Based on NIH | Are headaches a common symptom of fibromyalgia, and what features distinguish fibromyalgia-related headaches from migraine or tension-type headaches?

Headaches are indeed common in fibromyalgia. Many people with fibromyalgia experience headaches, including migraines, alongside body-wide pain, fatigue, and sleep problems. ^[1] Headaches (often migraines) are listed among frequent accompanying symptoms in fibromyalgia by multiple respected clinical resources. ^[2] Educational materials for individuals living with fibromyalgia also note frequent migraine headaches as a common co‑occurring issue. ^[3]

How common and why it matters

• Headaches especially migraine and tension‑type often co‑occur with fibromyalgia and can be part of the overall symptom burden that includes fatigue, poor sleep, and mood symptoms. ^{[1] [4]}
• People with fibromyalgia are more likely to have headaches, including migraines, than the general population, reflecting overlapping pain‑processing pathways and central sensitization. ^[2]

Distinguishing features: fibromyalgia-related headaches vs migraine vs tension-type

While fibromyalgia can be associated with different headache types, the headache itself usually meets criteria for a primary headache (commonly migraine or tension‑type). The presence of fibromyalgia tends to change the “pattern” and associated symptoms rather than create a completely unique headache subtype.

Core patterns

• Migraine
  • Throbbing/pulsing pain, often one‑sided; attacks last 4–72 hours without treatment. ^[5]
  • Commonly accompanied by sensitivity to light/sound, nausea, and sometimes aura. ^[5]
• Tension‑type headache
  • Dull, pressure or tight band–like pain on both sides; linked to muscle tightness in neck/scalp and stress; not usually with nausea or light sensitivity. ^{[6] [7]}
• Headaches in fibromyalgia (what’s different)
  • Higher frequency and chronicity: Headaches are more likely to occur frequently or evolve into chronic daily patterns when fibromyalgia is present. ^[8]
  • Greater pericranial (scalp/neck) muscle tenderness and widespread pain sensitivity: Muscle tenderness around the head and neck is common and may amplify tension‑type features. ^[8]
  • Worse sleep, anxiety, and fatigue accompanying headaches: Poor sleep quality and anxiety often travel with frequent headaches in fibromyalgia, contributing to persistence and disability. ^{[8] [9]}
  • Overlap with both migraine and tension‑type: Chronic migraine and chronic tension‑type headache are particularly common in people with fibromyalgia, suggesting that central sensitization increases headache burden regardless of subtype. ^[9]

Practical clinical clues

• If the headache is throbbing, one‑sided, worsened by activity, and comes with light/sound sensitivity or nausea, it may fit migraine even in someone with fibromyalgia. ^[5]
• If the headache feels like tight pressure on both sides, related to stress or neck muscle tightness, and lacks nausea/light sensitivity, it may fit tension‑type even in someone with fibromyalgia. ^{[6] [7]}
• If headaches are very frequent or daily, with marked scalp/neck tenderness, poor sleep, and anxiety, this pattern is commonly seen when fibromyalgia coexists and may require addressing sleep and central pain sensitization along with standard headache therapy. ^{[8] [9]}

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Comparison at a glance

Feature	Migraine	Tension‑type headache	Headaches with fibromyalgia
Pain quality/location	Throbbing/pulsing, often one‑sided	Dull/pressure, band‑like, usually both sides	Can resemble migraine or tension‑type; often mixed
Associated symptoms	Light/sound sensitivity, nausea; possible aura	Minimal associated symptoms; muscle tightness	Widespread pain, pericranial tenderness, poor sleep, anxiety, fatigue
Duration/frequency	4–72 hours if untreated; episodic or chronic	30 minutes to hours; episodic or chronic	Often higher frequency; more chronic profiles
Modifiers	Activity worsens; sensory triggers	Stress, posture, muscle tension	Central sensitization may amplify symptoms and disability

Sources for table details: migraine features. ^[5] Tension‑type features. ^{[6] [7]} Fibromyalgia‑related modifiers and chronicity. ^{[8] [9]}

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What to do about it

• Confirm the primary headache type (migraine vs tension‑type) because standard treatments still apply, but also screen for sleep problems, anxiety, and muscle tenderness since they often drive chronicity in fibromyalgia. ^{[8] [9]}
• Address sleep quality and stress management as part of the plan, as these factors strongly correlate with frequent headaches in fibromyalgia. ^[8]
• Remember that headaches are recognized as common in fibromyalgia by public health and clinical resources, reinforcing that you’re not alone and that targeted care can help. ^{[1] [2] [4]}

If you’d like, I can help map your headache pattern (triggers, frequency, associated symptoms) to the most likely type and suggest evidence‑based next steps tailored to fibromyalgia’s unique challenges.