Expert Answer: Migraine & Fibromyalgia

Question: What medications are effective for both chronic migraine and fibromialgia?

There are 3 medications that are FDA-approved for fibromyalgia. They are:
1. Cymbalta
2. Savella
3. Lyrica

None of these 3 medications are officially FDA-approved for migraine prevention. However, they can be used “off label” to prevent migraine. The choice of which one to use if an individual has both fibromyalgia and migraine may be based on the side-effect profile for each medication. Cymbalta is FDA approved for depression and anxiety as well as fibromyalgia so would be a good choice for patients who have fibromyalgia, depression, and migraines.

Savella is only FDA-approved for fibromyalgia in the United States but is approved for depression in European Countries. Savella is a little more energizing and more likely to cause weight-loss compared to Cymbalta so may be a better choice if an individual has migraine, fibromyalgia and a lethargic type of depression or is overweight and wants to lose some weight. Lyrica is related in its chemical structure to Neurontin (Gabapentin) and can be useful when both chronic migraine and fibromyalgia are present but can cause weight gain and peripheral edema as well as sedation. However, Lyrica is not useful for depression.

Lyrica can be used with Cymbalta or Savella for the treatment of fibromyalgia but in general, Cymbalta and Savella are not used together.

My recommendation for most patients who have chronic migraine and fibromyalgia is Cymbalta and if necessary, Topamax and/or Botox if the Cymbalta is not enough for prevention of chronic migraine.

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