Not only is headache painful, but it is also disabling. In the Global Burden of Disease Study, updated in 2013, migraine on its own was found to be the sixth highest cause worldwide of years lost due to disability (YLD). Headache disorders collectively were third highest. WHO
I have to say this doesn’t surprise me. I don’t know where Fibromyalgia ranks, and I know it is variable between people, but my chronic migraines impair me more. For example fibromyalgia has limited what type of job I can do, certainly, but I can do a desk job with moderate pain perfectly fine with careful attention to issues of fibrofog… in other words I have to compensate in certain ways to function well, but I can do it. Chronic migraines impair me at all jobs. Period. Make it difficult to get to work. Missed a lot of work. Made it difficult to function on the days I made it to work. And the Suffering was always there, just far more consistent pain that couldn’t be relieved or compensated for.
Course having them both rather complicates the situation. Sort of feed off each other in negative ways. Nevertheless, chronic migraines have strongly impacted my life, whereas I had learned rather well to cope with the FM. I think really it was a matter of how to cope with it to be honest. With FM I learned to live within my limits. To moderate my activities and to pace myself. With migraines it literally doesn’t matter if you do those things, as it will come on anyway. You can do trigger management but once they are chronic, it seems like existence itself is a trigger. And some triggers simply cannot be avoided. While others were caused by the FM itself, like lack of sleep. So my coping strategies were well developed to FM and work out quite well, even though you have to deal with flare ups, symptoms becoming an issue, comorbid conditions and sometimes exceeding those limits. With chronic migraines it is like your brain is Always exceeding its limits and is always overly sensitive to its environment and hyped up for pain. It becomes a matter of how to cope with suffering. How to reduce suffering. How to live with suffering. And this, is quite another game altogether and this has a greater impact on life.
A recent study in Neurology has shown that people with comorbid fibromyalgia and migraines are at higher risk of suicide. Both conditions alone come with a higher risk of suicide as is. They found that people with comorbid FM and migraines experienced poorer sleep quality… which is hardly a surprise since one of the major FM symptoms is sleep dysfunction, but it also happens to be a migraine trigger. And this, in my personal experience, can be a viscous cycle. Sleep deprivation and status migraines certainly plummet my mood and have led to suicidal ideation and suicidal intent.
Migraines and FM are pretty comorbid with the with around 35% having FM and chronic migraines. Episodic it is a range of 12-31%.
In the study of 1,318 migraine patients, 10.1 % were found to also have comorbid FM. Of the migraine patients, 27.3 % reported suicidal ideation and 6.9 % reported suicide attempts and were higher in patients with comorbid FM than in those without; ideation: 58.3% and attempt: 17.6%. With higher risk in the subgroups of migraine with aura, migraine without aura and chronic migraines.
To put that into perspective the rate of suicide in the world is 1.8% and the rate of suicide attempts is 2.7%. One study in Spain looking at FM patients found 16.7 % attempted suicide 1 to 3 times. A Demark study found suicide attempts in FM patients 10.5 times greater than the population average.
This is why unmanaged pain is a problem. And I should know, when my pain wasn’t managed I had a great deal of suicidal ideation and a suicide attempt. If anyone had asked me why, I would have said it was madness to continue an existence like that willingly. Forcing myself to work. Enduring that suffering. With a smile on my face. There is no valid reason to let someone suffer like that. None at all. And inevitable they will seriously consider ending their lives. I was in this survival mode of pain for more than a decade… how could it Not have occurred to me without proper treatment?
Pain should be taken very seriously. It doesn’t seem to be these days. And that concerns me a great deal. It is as if lives don’t matter. Quality of life doesn’t matter. The fact suicide occurs when Pain exceeds our capacity to Cope with it.
You add in chronic migraines with fibromyalgia… or complicate an already complicated pain situation with more pain and of course suicide risk factors increase. This is why pain treatment has to be managed carefully, looking at the entire person and addressing all issues. Coping, mood, the pain, work and family. And any other factor the patient sees as important for their care. It isn’t just medication. It is the strategies to deal with what the medication cannot treat, and it cannot treat that much of the pain to be honest.