Fibromyalgia and headaches are closely linked. More than half of people with fibromyalgia experience migraines, and the connection runs deeper than coincidence. The same disruption in how the brain processes pain signals appears to drive both conditions, which is why headaches are formally recognized as a core symptom of fibromyalgia in its diagnostic criteria.
How Common Are Headaches in Fibromyalgia?
In a study published in Headache: The Journal of Head and Face Pain, 55.8% of fibromyalgia patients met the clinical criteria for migraine headaches. That’s dramatically higher than the general population, where migraines affect roughly 12% of adults. Tension-type headaches are also common in fibromyalgia, though migraines tend to get more attention because of their severity.
Headaches aren’t just a side effect of living with fibromyalgia. They’re baked into the diagnosis itself. When the American College of Rheumatology revised its fibromyalgia diagnostic criteria in 2011, headaches became one of only three somatic symptoms scored alongside widespread pain. The other two are abdominal pain and depression. Going back even further, chronic headache appeared as a diagnostic criterion in the earliest formal descriptions of fibromyalgia in 1981. If you have fibromyalgia and frequent headaches, you’re experiencing one of the condition’s most recognized features.
Why Fibromyalgia and Headaches Share the Same Root
The core problem in fibromyalgia is something called central sensitization: the pain-processing neurons in your brain and spinal cord become hyperresponsive to normal signals. Think of it as the volume knob on your nervous system being turned up too high. Sensations that wouldn’t normally register as painful, or would cause only mild discomfort, get amplified into significant pain. This same mechanism plays a major role in chronic migraines.
In fibromyalgia, imaging studies show measurable changes in brain regions responsible for processing and regulating pain, including altered gray matter volume in the prefrontal cortex, thalamus, and other areas. The descending pain-modulating system, which is your brain’s built-in ability to dial pain signals down, doesn’t function properly. These aren’t subtle differences. They show up on brain scans as changes in structure, blood flow, and how different regions communicate with each other.
The same sensitization process that causes widespread body pain can settle into the nerves of your head and neck. When second-order pain neurons in the cervical spine and trigeminal system (the nerve network responsible for head and face sensation) become permanently sensitized, the result is persistent headaches and scalp tenderness. Researchers describe this as a self-reinforcing loop: headaches increase, pericranial muscle pain develops, sensitization deepens, and pain spreads further.
The Chemistry Behind Both Conditions
People with fibromyalgia have measurable imbalances in several brain chemicals that directly affect pain perception. Serotonin and norepinephrine, two neurotransmitters essential for the brain’s ability to suppress pain signals, are found at lower levels in fibromyalgia patients. At the same time, substance P, a neuropeptide that amplifies pain signaling in the spinal cord, is elevated in their spinal fluid. Glutamate, an excitatory brain chemical, is also elevated.
This combination creates a nervous system that’s less able to quiet pain and more prone to amplifying it. Serotonin is particularly important here because it plays a dual role: it helps inhibit pain through one pathway while also facilitating pain through another. When serotonin levels drop, the balance tips toward more pain, not less. This same neurochemical profile contributes to both the body-wide tenderness of fibromyalgia and the recurrent headaches that come with it.
How Headaches Become Chronic in Fibromyalgia
One of the more frustrating aspects of fibromyalgia-related headaches is their tendency to become chronic. People who might have started with occasional migraines or tension headaches often find that the frequency and intensity increase over time. Research points to a specific progression: the central sensitization that persists between headache attacks prevents your nervous system from ever fully resetting. In someone without fibromyalgia, the brain typically returns to baseline between headache episodes. In fibromyalgia, the sensitization lingers.
Scalp tenderness, or allodynia (where normally painless touch becomes painful), is a key marker of this process. During a migraine, many people temporarily develop sensitivity on their scalp or face. In fibromyalgia patients, this sensitivity often persists even when they’re not having a headache, which signals that the underlying sensitization is always active. This persistent tenderness in the muscles and tissues around the skull contributes to the transformation from occasional headaches into chronic ones. Sleep disturbances and anxiety, both extremely common in fibromyalgia, further feed this cycle by reducing the brain’s ability to habituate to repeated pain signals.
Managing Headaches When You Have Fibromyalgia
The overlap between fibromyalgia and headaches has one practical upside: many of the same approaches help with both. The European Alliance of Associations for Rheumatology (EULAR) identifies exercise as the single strongest recommendation for fibromyalgia management, backed by the highest quality evidence. Regular aerobic exercise, even at moderate intensity, helps recalibrate pain processing over time. For headaches specifically, consistent physical activity reduces both frequency and severity in most people.
When non-drug approaches aren’t enough, certain medications can address both conditions simultaneously. Tricyclic antidepressants have shown significant pain-relieving effects across fibromyalgia, chronic headaches, and migraines. A class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs) also reduces fibromyalgia pain effectively, which makes sense given the serotonin and norepinephrine deficits underlying the condition. Standard SSRIs, by contrast, have not proven effective for headaches or migraines.
EULAR guidelines emphasize a graduated approach: start with education and non-drug strategies like exercise, then add psychological therapies for mood or coping difficulties, medication for severe pain or sleep problems, or a combined rehabilitation program for significant disability. The key point is that treating fibromyalgia and headaches as separate problems often leads to fragmented care. Because they share the same underlying mechanism, addressing the root sensitization tends to improve both.
What This Means for Your Headaches
If you have fibromyalgia and you’re getting frequent headaches, they’re almost certainly connected. The same neurological process that makes your muscles and joints hurt is sensitizing the pain pathways in your head and neck. Headaches in fibromyalgia aren’t a coincidence or a secondary complaint. They’re a direct expression of the same central nervous system dysfunction.
Tracking your headache patterns alongside your fibromyalgia flares can help you and your provider see the relationship more clearly. Many people notice that their headaches worsen during the same periods when their body pain, fatigue, and sleep problems intensify. That’s the shared sensitization at work, and it means that anything improving your overall fibromyalgia management, particularly consistent exercise and adequate sleep, is likely to reduce your headache burden as well.