Headaches can be a debilitating problem for anyone especially if they become chronic and persistent. The fact that fibromyalgia (FM) sufferers are more prone to headache combined with the other chronic pain issues can make for a very complex situation. Because there are so many cause of headache knowing what to focus on first is a common dilemma for FM suffers and their health professionals. Known physical triggers such as muscular tension, neck arthritis, eye strain, jaw (TMJ) dysfunction and night teeth grinding (Bruxism) are often fairly easy to diagnose, especially when they are co-existing in a case of FM, and can be addressed. However, chronic headache can present in the absence of all physical triggers forcing one to seek a deeper understanding of the cause. As part of the diagnostic work up various inflammatory and hormonal problems need to be considered such as sinus infection/inflammation, allergy, cyclical headaches that shadow the female hormonal cycle and in some cases an adverse reaction to the birth control pill. Naturally there are a myriad of other problems that can cause chronic headache so a consultation with your doctor is always an advisable step but for many FM sufferers the cause of their headache is often never found and a long-term course of pain relief medication is the only treatment offered. Ironically, the long-term use of certain pain relief medication can actually cause headache! Drugs that contain codeine or a mixture of codeine and paracetamol are probably the worst culprits, but medication-overuse headaches can also occur on anti-inflammatory drugs and some medication used in the management of migraine such as triptans. If you feel you are taking any of these drugs for an extended period you should take a look at the web link at the end of this article and have a chat with your doctor.
As already mentioned, in many cases of FM-headache the exact cause is never discovered. This prompted a team from Spain to investigate the link that has been proposed to exist between oxidative stress and many of the symptoms associated with FM including headache. Before we take this any further, the term ‘oxidative stress’ needs some clarification. As paradoxical as it may sound, oxygen is a toxic substance when it’s not harnessed into chemical reactions needed for life or removed from the cells where, if freely available, it can cause damage through a process known as oxidation. We have all seen the effects of oxygen and oxidation on over ripe fruit or even on metal work such as the rust seen on the surface of iron exposed to the air. In a similar way, oxygen can punch holes in cell membranes and even damage the DNA found within the heart of our cells. Oxygen can be bad news to a cell and it’s this process that the term ‘oxidative stress’ owes its origins. All form of life have chemical systems that aim to reduce the oxidative stress by using special cellular enzymes but if the oxidative stress becomes too great these systems become overwhelmed. Many chronic health problems (atherosclerosis, chronic fatigue syndrome, Alzheimer’s disease, fibromyalgia and even Parkinson’s disease) have been associated with excessive oxidative stress either due to lifestyle habits (poor diet, smoking etc…) or a defective set of enzyme reactions that would normally deal with the overload of free and super-reactive oxygen (free-radicals) molecules. Returning to the Spanish study, the scientists theorised that oxidative stress may be a contributing factor for the development of chronic headache in FM suffers. They then took the work a step further using the established knowledge that FM sufferers are known to display low levels of Co-Enzyme Q10 (CoQ10), a key enzyme in the metabolic chain reaction needed to reduce oxidative stress. Those with low Co-Q10 levels were also known to have higher levels of free radicals (bad oxygen molecules) contained within special cellular structures called mitochondria. Co-Q10 is normally concentrated within these structures so the possibility existed that re-dressing the deficiency could enhance the free-radical clearance, reduce the oxidative stress and in so doing improve many of the FM symptoms (including headache) that has been attributed to excessive oxidative stress.
The team set about working with FM suffers with an established 2 to 3 year diagnosis who were free of active infections or other medical causes for their headaches; they fitted the category for headache of unknown origin! As part of the study, blood tests were performed to determine the FM sufferer’s levels of CoQ10 and markers that indicated the level of oxidative stress (lipid peroxidation) and cellular energy production (ATP). Once all the pre-treatment results were in the FM sufferers were given 100mg of CoQ10 three times a day for 3 months.
Following the 3 month treatment period all the blood tests were performed again. Interestingly, those with low CoQ10 levels also had low levels of ATP and high levels of oxidative stress. The study confirmed a significant correlation between FM headache (and pain in general) and high levels of oxidative stress. The study went on to demonstrate a marked improvement in headache symptoms that followed the correction of the high level of oxidative stress. This effect was attributed to the effects of improved Co-Q10 levels and it’s free-radical reducing actions within the mitochondria. The scientists had their work published this April in the journal, Public Library of Science which is freely available online. With the authors final comments reflecting a ‘remarkable improvement’ in the clinical symptoms of headache in FM a trial of Co-Q10 may worth consideration in cases of ‘headache of unknown origin’. However, as always, do chat to your doctor before making any changes to your treatment.
1. Self help information on medication-overuse headaches: http://www.patient.co.uk/health/Headache-Medication-Induced.htm
2. Oxidative Stress Correlates with Headache Symptoms in Fibromyalgia: Coenzyme Q10 Effect on Clinical Improvement available at the Public Library of Science: www.plosone.org
3. Product link: 100mg Co-Q10