ALPIMS • UNDERSTANDING CONNECTIONS
Migraine &
Chronic Fatigue
Migraine can affect energy as well as pain. Persistent fatigue deserves its own assessment.
Fatigue is real.
Support should fit your energy and recovery needs.
One section at a time.
Read what helps. Leave the rest for later.
01 Can migraine cause fatigue? Before, during and after an attack
Fatigue can be part of a migraine attack. You may feel unusually tired before head pain begins or feel drained after it settles.
Recovery can include brain fog and difficulty concentrating. Frequent attacks may leave little recovery time.
However, ongoing exhaustion should not automatically be explained by migraine.
02 Is chronic fatigue the same as ME/CFS? A symptom and a specific illness are different
Chronic fatigue describes persistent fatigue. It can have many causes.
ME/CFS is a specific illness involving reduced function, disabling fatigue, post-exertional malaise, unrefreshing sleep or sleep disturbance, and cognitive difficulties.
A clinician assesses the pattern and checks other explanations. Fatigue alone does not diagnose ME/CFS.
03 How are migraine and ME/CFS connected? They can occur together
Studies have found migraine among people with ME/CFS, and significant fatigue among people with migraine.
Much of this evidence comes from selected clinical groups and cross-sectional studies. Estimates vary with the diagnostic criteria used.
This does not establish that one causes the other. Both conditions may need care.
04 What is post-exertional malaise? A delayed worsening after activity
Post-exertional malaise (PEM) is a worsening of symptoms after activity that exceeds a person’s capacity.
Physical, mental, emotional or social effort can contribute. The worsening may be delayed by hours or days, and recovery can be prolonged.
It is more than ordinary tiredness. If this pattern happens, tell your clinician.
If you have ME/CFS or suspected PEM, do not push through symptoms. NICE advises against programmes that use fixed increases in exercise, including graded exercise therapy.
05 What may help day to day? Reduce demands and allow recovery
- Use your agreed migraine care plan.
- Break tasks into smaller parts and rest before becoming depleted.
- Count reading, conversations and sensory demands as activity too.
- Ask for practical help and a comfortable place to rest.
For ME/CFS, energy management should stay within your current limits and adapt when symptoms change. Pacing is not a cure or a requirement to increase activity.
General migraine exercise advice needs adapting if you have PEM.
06 What can professional care check? Look beyond a single explanation
A GP can assess persistent fatigue, review medicines and consider other contributors, such as anaemia, thyroid problems or sleep disorders.
Migraine treatment may reduce attack-related fatigue, but it may not resolve a separate fatigue illness.
Tell your clinician about delayed crashes, unrefreshing sleep, dizziness when upright and medicine side effects.
New or changing symptoms need assessment. Do not assume everything is migraine or ME/CFS.
Professional care ↗07 ALPIMS notes & references Support the whole picture
Pain, autonomic symptoms, sensory load, sleep and daily demands may all affect what is manageable.
One adjustment may help several needs. A quieter room may reduce sensory demands while making migraine recovery and rest easier.
These practical connections do not mean every ALPIMS domain causes fatigue.
08 When should I seek urgent help? Sudden or severe changes
Call 000 in Australia for a sudden extremely severe headache, new weakness, difficulty speaking, confusion, severe breathing difficulty or chest pain.
Seek urgent medical assessment for headache with fever and a stiff neck, or a new severe headache after head injury.
Arrange a GP review if fatigue persists, worsens or limits daily life.