title: Impact of migraine on fibromyalgia symptoms.
abstract: BACKGROUND
  Fibromyalgia (FMS) and high frequency episodic/chronic migraine (M) very frequently co-occur, suggesting common pathophysiological mechanisms; both conditions display generalized somatic hyperalgesia. In FMS-M comorbidity we assessed if: a different level of hyperalgesia is present compared to one condition only; hyperalgesia is a function of migraine frequency; migraine attacks trigger FMS symptoms.
  
  
  METHODS
  Female patients with fibromyalgia (FMS)(n.40), high frequency episodic migraine (M1)(n.41), chronic migraine (M2)(n.40), FMS + M1 (n.42) and FMS + M2 (n.40) underwent recording of: -electrical pain thresholds in skin, subcutis and muscle and pressure pain thresholds in control sites, -pressure pain thresholds in tender points (TePs), -number of monthly migraine attacks and fibromyalgia flares (3-month diary). Migraine and FMS parameters were evaluated before and after migraine prophylaxis, or no prophylaxis, for 3 months with calcium-channel blockers, in two further FMS + H1 groups (n.49, n.39). 1-way ANOVA was applied to test trends among groups, Student's t-test for paired samples was used to compare pre and post-treatment values.
  
  
  RESULTS
  The lowest electrical and pressure thresholds at all sites and tissues were found in FMS + M2, followed by FMS + H1, FMS, M2 and M1 (trend: p < 0.0001). FMS monthly flares were progressively higher in FMS, FMS + M1 and FMS + M2 (p < 0.0001); most flares (86-87 %) occurred within 12 h from a migraine attack in co-morbid patients (p < 0.0001). Effective migraine prophylaxis vs no prophylaxis also produced a significant improvement of FMS symptoms (decreased monthly flares, increased pain thresholds)(0.0001 < p < 0.003).
  
  
  CONCLUSIONS
  Co-morbidity between fibromyalgia and migraine involves heightened somatic hyperalgesia compared to one condition only. Increased migraine frequency - with shift towards chronicity - enhances both hyperalgesia and spontaneous FMS pain, which is reversed by effective migraine prophylaxis. These results suggest different levels of central sensitization in patients with migraine, fibromyalgia or both conditions and a role for migraine as a triggering factor for FMS.
authors.affiliation: Fibromyalgia and Headache Center, Geriatrics Clinics, Department of Medicine and Science of Aging and Ce.S.I., "G. D'Annunzio" University of Chieti, via dei Vestini s.n., 66100, Chieti, Italy. mag@unich.it.
authors.forename: Maria Adele
authors.initials: MA
authors.lastname: Giamberardino
authors.affiliation: Fibromyalgia and Headache Center, Geriatrics Clinics, Department of Medicine and Science of Aging and Ce.S.I., "G. D'Annunzio" University of Chieti, via dei Vestini s.n., 66100, Chieti, Italy.
authors.forename: Giannapia
authors.initials: G
authors.lastname: Affaitati
authors.affiliation: Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, "Sant'Andrea" Hospital, "Sapienza" University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Martelletti
authors.affiliation: Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tana
authors.affiliation: Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, "Sant'Andrea" Hospital, "Sapienza" University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Negro
authors.affiliation: Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Lapenna
authors.affiliation: Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, "Sant'Andrea" Hospital, "Sapienza" University, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Curto
authors.affiliation: Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Cosima
authors.initials: C
authors.lastname: Schiavone
authors.affiliation: Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Stellin
authors.affiliation: Fibromyalgia and Headache Center, Geriatrics Clinics, Department of Medicine and Science of Aging and Ce.S.I., "G. D'Annunzio" University of Chieti, via dei Vestini s.n., 66100, Chieti, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cipollone
authors.affiliation: Institute of Surgical Pathology, "G. D'Annunzio" University of Chieti, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Costantini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006930:Hyperalgesia / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold; D012720:Severity of Illness Index; D012867:Skin / Q000503:physiopathology; D063189:Symptom Assessment; D055815:Young Adult
keywords: Central sensitization; Fibromyalgia; Hyperalgesia; Migraine; Pain thresholds; Tender points