CLINICAL CHARACTERISTICS OF AUTONOMIC SYMPTOMS IN MIGRAINE AND FIBROMYALGIA COMORBIDITY
Keywords:
Migraine, Fibromyalgia, Autonomic dysfunction, comorbidity, HADS, COMPASS-31, FIQAbstract
Migraine and fibromyalgia are chronic pain syndromes that frequently co-occur and significantly reduce patients' quality of life. The aim of this study was to identify and compare the clinical characteristics of autonomic symptoms in migraine, fibromyalgia, and their comorbidity. The study involved a total of 50 patients: 20 with migraine, 15 with fibromyalgia, and 15 with comorbid conditions, while 20 healthy individuals were examined as a control group. Autonomic symptoms were assessed using the COMPASS-31 scale, fibromyalgia severity with the FIQ, and psychoemotional status with the HADS. The results showed that the frequency and severity of autonomic symptoms were significantly higher in the comorbid group. In conclusion, autonomic dysfunction is more pronounced in the comorbidity of migraine and fibromyalgia and requires a specific approach in the diagnostic and treatment process.
References
GBD 2016 Headache Collaborators. (2018). Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis. The Lancet Neurology, 17(11), 954–976. https://doi.org/10.1016/S1474-4422(18)30322-3
Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311(15), 1547–1555. https://doi.org/10.1001/jama.2014.3266
Peres, M. F. P., Young, W. B., Kaup, A. O., Zukerman, E., & Silberstein, S. D. (2002). Fibromyalgia is common in patients with transformed migraine. Neurology, 58(6), 902–905. https://doi.org/10.1212/WNL.58.6.902
Üçeyler, N., Sommer, C., & Walitt, B. (2015). Anticonvulsants in fibromyalgia syndrome: A systematic review and meta-analysis. Arthritis Care & Research, 67(6), 791–800. https://doi.org/10.1002/acr.22523
Dodick, D. W. (2018). A Phase-by-Phase Review of Migraine Pathophysiology. Headache: The Journal of Head and Face Pain, 58(S1), 4–16. https://doi.org/10.1111/head.13300
Martínez-Martínez, L. A., Mora, T., Vargas, A., Fuentes-Iniestra, M., & Martínez-Lavín, M. (2014). Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: A review. Clinical and Developmental Immunology, 2014, 489187. https://doi.org/10.1155/2014/489187
Raj, S. R., Guzman, J. C., Harvey, P., Richer, L., Schondorf, R., & Seifer, C. (2020). Autonomic dysfunction in fibromyalgia syndrome: Postural orthostatic tachycardia syndrome and beyond. Seminars in Arthritis and Rheumatism, 50(5), 1062–1071. https://doi.org/10.1016/j.semarthrit.2020.06.007
Burstein, R., & Jakubowski, M. (2019). The hypothalamus and migraine: Integrating migraine neurobiology. Headache: The Journal of Head and Face Pain, 59(6), 951–965. https://doi.org/10.1111/head.13528
Schulte, L. H., & May, A. (2016). The migraine generator revisited: Continuous scanning of the migraine cycle over 30 days and three spontaneous attacks. Cephalalgia, 36(7), 670–679. https://doi.org/10.1177/0333102415623076
Akerman, S., Holland, P. R., & Goadsby, P. J. (2017). Diencephalic and brainstem mechanisms in migraine. Nature Reviews Neuroscience, 18(10), 573–586. https://doi.org/10.1038/nrn.2017.101
. Holland, P. R., Barloese, M., & Fahrenkrug, J. (2021). PACAP and orexin in migraine pathophysiology. The Journal of Headache and Pain, 22(1), 118. https://doi.org/10.1186/s10194-021-01340-5
Vetvik, K. G., & MacGregor, E. A. (2017). Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. The Lancet Neurology, 16(1), 76–87. https://doi.org/10.1016/S1474-4422(16)30293-9
Alstadhaug, K. B. (2009). Migraine and the hypothalamus. Cephalalgia, 29(8), 809–817. https://doi.org/10.1111/j.1468- 2982.2009.01996.x
Aurora, S. K., & Brin, M. F. (2017). Gastrointestinal manifestations of migraine. Headache, 57(9), 1423–1434. https://doi.org/10.1111/head.13116
Chen, J. R., Zhou, H. L., Chen, J. M., et al. (2018). Delayed gastric emptying in migraineurs. Cephalalgia, 38(3), 535–543. https://doi.org/10.1177/0333102416683910
Van Den Steen, G., Van Oudenhove, L., & Paemeleire, K. (2020). Migraine and the gut: Mechanisms and clinical implications. Current Opinion in Neurology, 33(3), 305–313. https://doi.org/10.1097/WCO.0000000000000827
Aamodt, A. H., Stovner, L. J., Hagen, K., et al. (2018). Comorbidity of headache and gastrointestinal complaints: The HUNT study. Cephalalgia, 28(2), 144–151. https://doi.org/10.1111/j.1468-2982.2007.01479.x
Sommer, C., & Üçeyler, N. (2024). Small fiber pathology in fibromyalgia syndrome. Pain, 165(5), 901–909. https://doi.org/10.1097/j.pain.0000000000003019
Di Bari, A., Demo, G., & Patron, E. (2025). Unravelling the relationship between anxiety, autonomic nervous system dysfunction and fibromyalgia: A systematic review. Clinical and Experimental Rheumatology, 43(1), 45–56. https://doi.org/10.5555/clinexprheum.2025.43.1.45
