E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Fatigue in chronic migraine patients.
Peres, M F P, Zukerman, E, Young, W B et al. · Cephalalgia : an international journal of headache · 2002 · DOI
Quick Summary
This study looked at fatigue in 63 patients with chronic migraine headaches. The researchers found that most of these patients experienced significant fatigue, and many met the diagnostic criteria for chronic fatigue syndrome (CFS). The study suggests that fatigue and migraines may be connected conditions that should be recognized and treated together.
Why It Matters
This study demonstrates substantial overlap between chronic migraine and CFS, with the majority of migraine patients meeting CFS diagnostic criteria. Understanding this comorbidity relationship is crucial for both ME/CFS and migraine specialists, as it suggests shared pathophysiological mechanisms and has implications for how patients are diagnosed and treated across both conditions.
Observed Findings
84.1% (53/63) of chronic migraine patients had FSS scores ≥27 indicating significant fatigue
66.7% (42/63) of CM patients met full CDC diagnostic criteria for CFS
50.8% (32/63) met modified CDC criteria when headache was excluded
Depression and trait anxiety scores correlated with all fatigue scales measured
Physical fatigue was associated with fibromyalgia comorbidity; women reported higher FSS scores than men
Inferred Conclusions
Fatigue is highly prevalent in chronic migraine patients and frequently meets diagnostic thresholds for CFS as a disorder, not merely as a symptom
Psychological factors (depression, anxiety) are significantly associated with fatigue severity in CM patients
Fatigue in CM may have distinct subtypes (physical vs. mental) with different clinical correlates
Therapeutic recognition of both fatigue and headache in these patients could improve diagnosis and treatment outcomes
Remaining Questions
Does fatigue in CM patients reflect true CFS or a distinct fatigue syndrome with different pathophysiology?
What This Study Does Not Prove
This study does not establish causality or directionality—it cannot determine whether migraine causes fatigue, fatigue causes migraines, or whether both stem from a common underlying mechanism. The absence of controls means we cannot determine if fatigue prevalence in CM patients is significantly higher than in the general population or other chronic conditions. Cross-sectional design also cannot establish whether fatigue precedes or follows migraine onset.
Tags
Symptom:PainFatigue
Method Flag:Weak Case DefinitionNo ControlsSmall Sample
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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