Headaches in Fibromyalgia

Published: January 14, 2014

Headaches are common in fibromyalgia. And how a person describes their headache gives a pretty good idea of its source. For example:

Migraine Headaches

These are often associated with an "aura" such as visual changes, last over 24 hours, and cause light and sound sensitivity.

Muscle Tension Headaches

These are usually felt across the forehead, along with tenderness in the temples and neck, and the neck is often the source of the headache. Other sources include the muscle insertion site at the base of the skull (in this case the headache is usually felt at the base of the skull, the top of the head or behind the eyes), and tense facial muscles.

Sinus Headaches

These tend to be behind the eyes or around the middle of the face, with pain worsened by applying pressure to the sinuses.

The S.H.I.N.E. protocol combined with specialized treatments for each type of headache can be very helpful in alleviating these kinds of headaches. For example, migraine headache frequency can be reduced by taking vitamin B2 (400 mg), Butterbur, magnesium, and coenzyme Q10 for at least 6 weeks, and by addressing fluctuations in estrogen and progesterone in those who have cyclic headaches. If present, treating for Candida with Diflucan, including using a special sinusitis nose spray to treat infections, is very helpful for eliminating chronic sinusitis.

In rare cases, some people have persistent, severe headache problems that don't fit one of the types of headaches above. Instead of feeling the headache in a specific area, they describe it as a feeling of "too much pressure" in their entire head.

They might be right. A recent study looked at people with fibromyalgia who had severe headaches where the practitioner felt the pattern to be unusual enough to recommend a spinal tap. Five of the 20 people selected for this had elevated intracranial pressure on spinal tap, with many more having improvement in pain and/or function that lasted from a few minutes to a few weeks. Many factors may contribute to this, including the decreased outflow of blood via the veins draining the head. This most often likely occurs because of the effect of fibromyalgia on heart function, though it may also be caused by birth control pills and head injury triggering clots in the veins. This may be another reason why sleeping with the head slightly elevated (facilitating drainage) can result in symptomatic improvement, and why the blood thinner heparin can be so helpful in many people with CFS and fibromyalgia.

I don't, however, recommend having a spinal tap for this. It's a nasty procedure and the benefits are transient. As an alternative, we have had some success using a medication called a "carbonic anhydrase inhibitor" to lower pressure inside the brain. (Acetazolamide or Diamox 125-500 mgs once or twice a day may decrease severe pressure headaches — carbonated beverages taste funny while you're on this medication).

I suspect that another treatment called "Craniosacral Therapy" might also be helpful here, and I'd welcome opinions from any Craniosacral Therapists out there.

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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