Fibromyalgia headaches are very common, and most of them meet the criteria for migraine, tension-type headache, or both. In one U.S. study, 76 of 100 people with fibromyalgia had chronic headache. The leading explanation is the same one behind the body pain: a nervous system that turns the volume up on pain signals, a process called central sensitization, rather than damage in the head or neck.
Below: what kind of headache fibromyalgia brings, why it so often sits at the back of the head and neck, what one study found about migraines setting off fibro flares, and what else to rule out when the headaches come every day. Please don’t start, stop or change any medication because of anything here without talking to your doctor first. Our fibromyalgia page collects our other videos on the condition.
Prefer to watch? This article goes with our video, Fibromyalgia Headaches: Why the Volume Is Turned Up (12 min).
What type of headache does fibromyalgia cause?
Usually migraine, tension-type headache, or both. The international headache classification has no separate “fibromyalgia headache”, so doctors classify it by how it behaves.
The clearest snapshot comes from a 2005 study of 100 people being treated for fibromyalgia in Pittsburgh.1 Seventy-six had chronic headache. When those 76 were sorted by the International Headache Society criteria, 63% had migraine (alone or together with tension-type headache) and 18 people had tension-type headache alone. Six had probable headache from overusing painkillers. These weren’t mild headaches either: 84% scored in the substantial or severe range on a standard headache-impact questionnaire.
One detail from that study surprised us. People with and without headache had similar body pain, sleep and distress scores. So headache didn’t mark a sicker subgroup; the authors read it as part of fibromyalgia itself.
How common are headaches with fibromyalgia?
Very, though the number depends on who is counted.
- Starting from a headache clinic. An Italian headache center in Bari studied 889 people with primary headaches (published in 2011) and found fibromyalgia in 174 of them, about 1 in 5.2 It was most common in tension-type headache (35%), rising to 44% in chronic tension-type headache, meaning headache on 15 or more days a month.
- Starting from chronic migraine. Across four Korean university hospitals, 91 of 136 new patients with chronic migraine (67%) met the 2010 fibromyalgia criteria, compared with 9 of 35 (26%) with chronic tension-type headache.3
- Starting from fibromyalgia. The Pittsburgh study above: 76%.1
The studies used different patients and different fibromyalgia criteria, so treat these as ballpark ranges, not one statistic. The direction is consistent, and it keeps showing up in new work. A 2026 study of 384 people with migraine in Egypt found that the 114 who also had fibromyalgia had more migraine days a month and higher headache-impact scores than those with migraine alone.4 It was a snapshot, so it can’t say which drives which.
Why does fibromyalgia cause headaches?
Start with what fibromyalgia isn’t. It isn’t classified as an autoimmune disease. There’s no immune attack on the body’s own tissues the way there is in rheumatoid arthritis or lupus. The World Health Organization’s ICD-11 places chronic widespread pain, including fibromyalgia, under “chronic primary pain”.5 Pain researchers class fibromyalgia as nociplastic pain: pain that comes from the pain-processing system itself being altered, rather than from damaged tissue or damaged nerves. Their 2021 Lancet review names tension-type headache as another example.6 A 2025 international consensus adds that some people with fibromyalgia also have tissue or nerve pain on top, so it can be a mix.7
The engine behind nociplastic pain is central sensitization. The spinal cord and brain stop scaling pain signals in proportion. Ordinary input arrives in the brain’s pain regions as an alarm instead of a whisper. A 2026 review in the Journal of Pain Research describes the main pieces: too much “go” signaling from chemical messengers like glutamate and substance P, too little “brake” from GABA, a weaker top-down system the brain normally uses to dial pain back down, and repeated stimuli that feel more painful each time instead of settling.8
The study that made this visible is small and more than 20 years old. In 2002, researchers pressed on the thumbnails of 16 people with fibromyalgia and 16 healthy volunteers inside an MRI scanner.9 The patients reached moderate pain at a little over half the pressure the volunteers needed. When the volunteers were pressed hard enough to hurt as much, their brain activity looked broadly similar to the patients’. At the same lower pressure, the patients showed more activation in 13 brain regions; the volunteers showed more in just one. The pressure caused no injury, so the extra activity came from how the patients’ nervous systems processed it.
Headache fits this picture: the head is wired into the same system, so in a sensitized nervous system it can hurt even when nothing is wrong with the scalp, the sinuses or the brain itself.
Why it hurts at the back of the head and neck
Two sets of nerves meet at the very top of the spinal cord, in an area called the trigeminocervical complex. Fibers from the trigeminal nerve, which carries feeling from the face, the front of the scalp and the coverings of the brain, share relay neurons there with fibers from the upper neck.
That shared relay is the standard explanation for why neck pain and head pain bleed into each other. In a 2003 experiment in rats, irritating the brain’s outer covering made those shared neurons more responsive to signals from the back of the head and neck muscles.10 That’s an animal study, used in migraine research to explain pain that spreads from forehead to neck. We couldn’t find a study of this meeting point in fibromyalgia itself. Our reading: in a nervous system that’s already turned up everywhere else, a junction where head and neck signals mix is a likely place for headache to start or spread.
It also fits what people describe. In the Italian headache-center study, tenderness of the muscles around the skull (pericranial tenderness) was one of the best signs separating headache patients who also had fibromyalgia from those who didn’t.2 In the Korean study, people with chronic migraine and fibromyalgia more often reported sensitivity to light and sound.3 If your scalp hurts to touch or your hair feels sore, that may be the same amplification showing up at the head. Scalp tenderness that is new, especially after 50 or with jaw pain when chewing or vision changes, needs a prompt check.
Can a migraine set off a fibromyalgia flare?
One study says it may. Researchers in Chieti, Italy, had women with fibromyalgia and frequent or chronic migraine keep two diaries for three months, one for migraine attacks and one for fibromyalgia flares.11 In both groups, 86 to 87% of fibro flares started within 12 hours after a migraine attack. Women with both conditions also had the lowest pain thresholds of anyone tested, lower than women with fibromyalgia alone or migraine alone.
In a second part of the study, women with fibromyalgia and frequent migraine, all on the same low dose of amitriptyline, either added a migraine-prevention drug, flunarizine, or chose not to. Over three months, the group taking it had fewer migraine attacks, fewer fibro flares, less rescue pain medicine and higher pain thresholds. The group without it didn’t change.
Two newer studies add to the picture: one points the same way, and one complicates it. In a 2025 Italian review of patient records, CGRP antibody treatments for migraine worked about as well in 26 people with fibromyalgia as in those without, and the fibromyalgia group also reported less body pain.12 A 2025 study from Taiwan found flunarizine helped fewer people with chronic migraine when fibromyalgia was also present: 32% responded well, against 52% without fibromyalgia.13 That was despite the fibromyalgia group also getting standard fibromyalgia treatment, mostly pregabalin. Two small studies can’t settle much. They do suggest the headache and the body pain are worth looking at together, which is a conversation for your doctors to have with each other and with you.
Fibromyalgia headaches every day: what else to rule out
Daily headache shouldn’t be assumed to be “just the fibro”. Some causes change what helps, and a few need prompt care.
| Possibility | What it looks like | Why it matters |
|---|---|---|
| Medication-overuse headache | Headache on 15 or more days a month in someone who already has a headache disorder, after more than 3 months of regular pain relievers: 15 or more days a month for simple ones like acetaminophen (paracetamol) or ibuprofen, 10 or more for triptans, opioids or combination pills.14 | It was diagnosed in 6 of the 76 Pittsburgh patients with headache.1 It needs a plan from your doctor, not stopping things on your own. |
| Chronic migraine | Headache on 15 or more days a month for over 3 months, with migraine features on at least 8 of them.14 | Two-thirds of chronic migraine patients in one study also met fibromyalgia criteria.3 |
| Chronic tension-type headache | Pressing or tight, band-like pain on 15 or more days a month, usually without nausea.14 | The headache type most tied to fibromyalgia at the Italian center.2 |
| Headache from the neck (cervicogenic) | Pain caused by a problem in the neck’s bones, joints or soft tissues, often one-sided, spreading from the back of the head forward and worse with certain neck movements.14 | It overlaps with how fibro headaches feel, so it’s worth a hands-on exam. |
| Red-flag headaches | Sudden “worst ever” onset, fever, weakness, numbness or vision changes, a new headache after 65, a clear change in pattern, headache that gets steadily worse, headache brought on by coughing, straining or a change in position, or any new headache with a history of cancer, a weakened immune system (including from immune-suppressing drugs), pregnancy or recent childbirth, or a recent head injury.15 | These can point to other causes. For a sudden severe headache, or one with weakness, numbness, confusion or vision loss, call emergency services. For the others, get seen promptly rather than waiting for a routine appointment. |
Why we care about this one
When Annesse, Kristin’s mom, got sick in the summer of 1992, daily migraines were part of it, along with muscle pain, low-grade fevers and flu-like aches. Doctors eventually confirmed lupus, chronic fatigue syndrome and fibromyalgia. Kristin was a teenager then, and for the next few years her mom was mostly in bed.
If we could go back, we’d ask her doctors whether the headaches and the body pain were connected, and we’d keep one diary for both, with the headache days and the flare days on the same page, and bring it to every appointment. We think that one habit would have made any link easier to see.
Questions to bring to your doctor
- Does my headache pattern meet the criteria for migraine, tension-type headache, or both?
- Could any of my headaches be from how often I take pain relievers, and if so, what’s the safe plan?
- Since migraine attacks may trigger fibromyalgia flares, can my headache care and my fibromyalgia care be planned together?
- Which headache changes should make me call you or go to urgent care?
What we still don’t know
Not everyone with fibromyalgia gets these headaches. In the Pittsburgh study, about a quarter had no chronic headache, and nobody has shown why the same turned-up nervous system produces head pain in some people and spares it in others.1 The imaging evidence for central sensitization in fibromyalgia was rated only moderate in a 2014 review of 22 brain MRI studies, which called for more research on cause and effect,16 and there’s still no scan that can diagnose it in one person. We found no study of the head-and-neck meeting point in fibromyalgia. The migraine-trigger finding rests mainly on one single-center study, and its treatment part wasn’t randomized. And researchers don’t agree on whether a “fibromyalgia headache” is its own thing or simply migraine and fibromyalgia sharing so much wiring that the line between them blurs.
Quick answers
What does a fibromyalgia headache feel like?
Most meet the criteria for migraine (throbbing, often with light and sound sensitivity or nausea), tension-type headache (a pressing band), or both. Many people also notice a sore scalp or a tender back of the head and neck.
Why do I get fibromyalgia headaches every day?
Frequent headache is common with fibromyalgia, but daily headache deserves a check for chronic migraine and for medication-overuse headache, which can develop when pain relievers are taken on 10 to 15 or more days a month for over 3 months. Don’t cut back on your own; ask your doctor for a plan.
Is fibromyalgia headache the same as migraine?
Often they overlap. In one study, 63% of people with fibromyalgia and chronic headache had migraine. Researchers still debate whether it’s a separate headache or migraine and fibromyalgia sharing the same amplified pain wiring.
Can a migraine trigger a fibro flare?
In one Italian diary study, 86 to 87% of fibro flares in women with both conditions began within 12 hours after a migraine attack. It’s a single study from one center, so it’s a lead, not proof.
Why does the back of my head hurt with fibromyalgia?
Nerves from the face and scalp share relay cells with nerves from the upper neck at the top of the spinal cord. In a sensitized nervous system, that junction may help explain why head and neck pain run together.
Sources
- Marcus DA, Bernstein C, Rudy TE. Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome. Clin Rheumatol. 2005;24(6):595-601. doi.org/10.1007/s10067-005-1121-x
- de Tommaso M, et al. Clinical features of headache patients with fibromyalgia comorbidity. J Headache Pain. 2011;12(6):629-638. doi.org/10.1007/s10194-011-0377-6
- Cho SJ, et al. Fibromyalgia among patients with chronic migraine and chronic tension-type headache: a multicenter prospective cross-sectional study. Headache. 2017;57(10):1583-1592. doi.org/10.1111/head.13191
- Hassan A, et al. Migraine with comorbid fibromyalgia: psychological burden and impact on frequency and severity of migraine attacks. Front Neurol. 2026;17:1776543. doi.org/10.3389/fneur.2026.1776543
- Nicholas M, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37. doi.org/10.1097/j.pain.0000000000001390
- Fitzcharles MA, et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110. doi.org/10.1016/S0140-6736(21)00392-5
- Saracoglu I, et al. Is fibromyalgia a nociplastic or a mixed-pain condition? International, multidisciplinary recommendations for pain phenotyping in fibromyalgia syndrome. Pain Physician. 2025;28(6):483-494. pubmed.ncbi.nlm.nih.gov/41337761/
- Hladkykh FV, et al. Central sensitization and nociplastic pain: shared mechanisms in fibromyalgia, osteoarthritis, and inflammatory arthritis. J Pain Res. 2026;19:571311. doi.org/10.2147/JPR.S571311
- Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002;46(5):1333-1343. doi.org/10.1002/art.10225
- Bartsch T, Goadsby PJ. Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain. 2003;126(Pt 8):1801-1813. doi.org/10.1093/brain/awg190
- Giamberardino MA, et al. Impact of migraine on fibromyalgia symptoms. J Headache Pain. 2016;17:28. doi.org/10.1186/s10194-016-0619-8
- de Tommaso M, et al. Efficacy of monoclonal antibodies against CGRP in migraine patients with fibromyalgia comorbidity: a retrospective monocentric observational study. J Headache Pain. 2025;26(1):102. doi.org/10.1186/s10194-025-02034-y
- Ling YH, et al. Comorbidity with fibromyalgia predicted poorer outcomes in patients with chronic migraine on flunarizine: prospective proof-of-concept study. Cephalalgia. 2025;45(6):3331024251353412. doi.org/10.1177/03331024251353412
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi.org/10.1177/0333102417738202
- Do TP, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134-144. doi.org/10.1212/WNL.0000000000006697
- Cagnie B, et al. Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Semin Arthritis Rheum. 2014;44(1):68-75. doi.org/10.1016/j.semarthrit.2014.01.001
How we made this article. We start from the research behind our video, draft with help from AI writing tools, and check every number and claim against the original papers listed above. Last fact-check: October 22, 2026. Spot an error? Tell us on any of our channels and we’ll fix it.
This article is education, not medical advice. It doesn’t diagnose or treat any condition. Talk to your doctor before changing your care, and never stop or change a medication on your own.
