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Migraine fatigue

Migraine Symptoms: Fatigue

Although it’s frequently overshadowed by more seemingly impactful symptoms like pain, nausea and sensitivity to light and sound, fatigue is a hallmark symptom of Migraine Disease.

According to a research study that asked patients to keep electronic diaries about their attacks, about 72% of Migraine patients who experience premonitory symptoms that alert them a Migraine attack is on the way experience fatigue. Fatigue is a state of extreme tiredness, weakness and exhaustion that can manifest itself either physically or mentally or both.

Fatigue among Migraine patients can be incredibly insidious because many of us experience it during most phases of the Migraine attack: Before the attack during the prodome phase, during the attack and after the attack during the postdome phase. And it’s even more burdensome for those living with Chronic Migraine, who often end up experiencing nearly constant fatigue. By one estimate 67% of people with Chronic Migraine meet the criteria for a diagnosis of Chronic Fatigue Syndrome.

Coping with high levels of fatigue, especially when you experience it frequently, is difficult. Here are a few strategies than can help:

  • Practice pacing.
  • Adjust your schedule to accommodate your needs and limits when possible.
  • Incorporate periods of rest into your day.
  • Strive to get some gentle exercise and movement into as many days as possible to prevent your fatigue from worsening.
  • Practice good sleep hygiene as often as possible / when a Migraine attack doesn’t interfere.

It may seem tempting to attribute Migraine-related fatigue to the burden of the pain and other symptoms associated with Migraine attacks, but it’s highly possible fatigue is related to the pathophysiology of Migraine (the disease process itself). It could be that fatigue is caused by the extreme neurological disruption involved in a migraine attack. Researchers don’t yet have confirmation of this, but as they learn more about the pathophysiology of Migraine, they come closer to being able to find out.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. Nicola J. Giffin, L. Ruggiero, Richard B. Lipton, Stephen D. Silberstein, J.F. Tvedskov, Jes Olesen, J. Altman, Peter J. Goadsby and A. Macrae. "Premonitory symptoms in migraine." Neurology March 25, 2003; 60(6): 935-940, doi: 10.1212/01.WNL.0000052998.58526.A9. 2. Mario Peres, Eliova Zukerman, William B. Young and Stephen D. Silberstein. "Fatigue in chronic migraine patients." Cephalalgia 2002 Nov;22(9):720-4, doi: 10.1046/j.1468-2982.2002.00426.x. 3. Roger K. Cady, Curtis P. Schreiber and Kathleen U. Farmer. "Understanding the Patient With Migraine: The Evolution From Episodic Headache to Chronic Neurologic Disease. A Proposed Classification of Patients With Headache." Headache 2004;44(5) doi: 10.1111/j.1526-4610.2004.04094.x.


  • Mizzquagmire
    3 years ago

    Does anyone actually have episodes of falling asleep, narcoleptic episosodes in essence, before it hits? I’ve had this happen a few times rather than the usual exhaustion, fatigue, and other pre migraine symptoms.

  • DonnaFA moderator
    3 years ago

    Hi Mizzquagmire, I have actually experienced that same thing on a number of occasions, it’s a very strange sensation. You may be interested in reading Community Thoughts: Managing Fatigue which discusses narcolepsy.

    Thanks for being part of the community! -All Best, Donna (Migraine,com team)

  • Eleanor R.
    3 years ago

    I posted a comment last August, and I want to report an improvement in my fatigue level that some members might consider. Besides the connection of my fatigues and migraine (one doc had said fatigue was a “migraine substitute”) I’ve discovered that a lot of my fatigue comes from a wheat sensitivity. I knew that I had to restrict my wheat, but I thought that small quantities were OK. Turns out, even the slightest amount of wheat (e.g., a tablespoon of cous cous) makes me tired within a day. I’ve been totally off wheat for more than a month, and my energy is significantly better. So this may be something for others to consider (or not, of course.)

  • Linda K.
    4 years ago

    Yes! I have chronic migraine, and for the past 2-3 years, I KNOW a migraine is coming when I become unaccountably extremely sleepy and/or tired. This most often happens during the first couple hours of the day, and I don’t wake up that way. It just hits me, and I know! On some days, it lasts all day, and along with the pain and mental challenges, I just have to sleep. Cannot rouse myself out of it for several hours. Very frustrating and a little scary to be so thoroughly knocked out! I wish I could say that when I finally wake up, the pain is gone, but that’s not the case. But at least I can function at some level then.For me, this is a worse symptom than the pain, although that is bad enough.

  • Eleanor R.
    4 years ago

    I’m grateful to for raising the topic of fatigue. I’m chronic migraine (pretty much daily.) One doctor said the fatigue, which I was getting on most migraine free days, was a “migraine substitute.” That meant I was disabled daily. Other docs seem to ignore it as soon as they hear the word “migraine,” and go with the migraine drugs, most of which are also soporific and don’t work for me (I’ve failed 20 or so prophylactics.) I’m well into senior years, so I’ve been able to cut way back on the demands of my life, but I really would like to be able to do more. Currently, I seem to need to sleep about 10 hours a night and rest (not quite nap) a couple of times a day for 20-30 min. Also brain fog/fatigue many mornings. No more details for now, but I hope follows up on the question of fatigue. (Brain fog topic a couple of days ago was helpful too.)

  • Anne
    4 years ago

    OMG! Thank you for this article and those who commented! I am suffering from chronic migraines and that is symptom I experience more than any others! I have to take naps on weekends and sometimes have to go to bed right after work. The more migraines I have – the more I sleep, until I find all I’m able to do is just go to work, eat and sleep – it takes too much energy to wash and blow dry my hair, so there are a lot of ponytail days 😉 It’s so relieving to hear that others suffer the same. I’m currently having Botox – on my third round and this is the second month. My migraines dropped to 8 this month (miracle!) and low and behold, my fatigue has lessened as well. I feel like a normal person and it’s strange to have energy – hope it lasts!!!

  • mygrainetoo
    3 years ago

    Anne- you might try adding a magnesium supplement, too. There seems to be a high correlation between migraines & low levels of both vitamin D and magnesium.

  • Anne
    4 years ago

    I just wanted to add – I was experiencing so much fatigue that I had several rounds of blood work done. Turns out, I am severely deficient in Vitamin D. The doctor prescribed large doses of Vitamin D for the next 3 months to be followed by more blood tests. It’s only the first week and i already feel an improvement! I have not had a migraine in four days (which is good for me). Anyone that’s experiencing extreme fatigue – please get blood work. It may be more than just your migraines.

  • Lifelongmigraines
    4 years ago

    I am also constantly tired, but like so many of you, I have learned to pace myself. Fortunately, I am on disability after teaching high school biology for twenty years. My husband passed away two years ago. Fatigue is definitely one of my triggers and my migraines got worse with menopause. They are hereditary in my family and I started having them when I was 16. I’m 55 now. Stress, fatigue, weather, bright lights, and strong odors are my triggers.

  • JanML
    5 years ago

    I had chronic daily migraines for 20 years, during which I took a beta-blocker, an antidepressant, and a triptan daily. I was never sure whether it was because of the migraines or the medications, but I was ALWAYS exhausted. Then, with menopause, my migraines began to improve, and after about four years, I was only suffering a mild migraine perhaps once or twice a week. Still chronic, I suppose, but a vast improvement over the past. Nevertheless, I was still exhausted all the time and speculated that perhaps this was indeed due to all the medications. So, very slowly, over a two-year period, I began to wean myself off the medications, with temporary increases in migraine frequency and severity as I did so, but eventual return to my “new normal.”

    Today, I am completely off the daily beta-blocker and triptan and down to half my usual dose of antidepressant. Some weeks I have a couple of mild migraines, and some weeks I have none. I often feel a quick “pulse” of migraine pain in my temple and neck, but it usually dissipates without developing into a full-blown migraine.

    And, if anything, I am even MORE exhausted every day than I was.

    I’m not complaining, mind you; I know that many women get little or no relief from migraines with menopause, so I’m very grateful that the horrendous pain I was in for so many years has lifted to a great extent. And I’ve undergone many tests that show I’m less anemic than I was, my vitamin levels are higher, any depression I had in the past has lifted – in fact, I’m healthier now in all respects.

    So . . . could my fatigue be due to a “lower level” chronic migraine that has worsened with the reduction in medications, I wonder? My doctors just shrug their shoulders, but it’s beginning to seem more and more likely.

  • JanML
    3 years ago

    I love that you asked that question, because I do think that my thyroid might indeed have something to do with my fatigue. Specifically, my thyroid was completely destroyed by radioactive iodine therapy many years ago due to my having intractable hyperthyroidism (Grave’s disease). Since then, I’ve been taking daily Synthroid, and my doctor assures me that I’m taking the highest possible dose (my TSH is practically zero). However, I know that I’ve never felt completely well since I lost my thyroid function (in fact, I suffered my first migraine shortly after I became hypothyroid); and recent studies indicate that, even when Synthroid levels are normal in the bloodstream, the level of thyroid hormone in the muscles and tissues may still be very low. I’ve recently been considering splitting my dose between morning and evening, rather than taking it all in the morning as I do now. This seems to increase some people’s morning energy, but makes it worse for others due to lack of sleep.

    Anyway, thanks for bringing up this issue, and I’m glad that the iodine supplement is helping! Many women’s thyroids begin to fail as they age, and I always tell my friends to find out exactly what their thyroid “numbers” are, because being in the “low-normal” range can impact their health much more than many doctors seem to think.

  • Kayakerjo
    3 years ago

    Have you had your thyroid checked? This can be another driver for fatigue and who knows the impact all the changes have had on it. My tests show thyroid function within normal levels but taking an iodine supplement to boost thyroid function seems to have helped my energy levels increase. Of course, be sure the iodine won’t do any damage for you first!

  • tucker
    6 years ago

    This is interesting, since my neuro ordered a sleep study for me back at my last appt. Chronic Migraines and the chronic pain in my neck and shoulders as well as some other medical problems (I think) were just wearing me out. I would sleep late on my days off (think noon), go to sleep right after coming home from work and leave my family high and dry for dinner, etc. This went on for over a year at least.

    I never did the sleep study since I wanted to consult my PCP about where to go at my annual physical since I do have some medical problems, and we decided that maybe the neuro could tinker with my meds after my lab work came back all skewed. I’m also at that mid-40’s age where the hormones “may” be starting to change (who knows since I’ve been irregular my entire life?- also had that talk with the gyn recently) and could be contributing to it – we’ve talked about it at work and all the moms agree that we are more sensitive to waking up no matter how old our kids are after having kids.

    But I’ve also started working out a couple months ago (a type of cross-fit/boot camp class which I do 2-3 days a week as I’m able) and wow, I really need to sleep after doing it. If I was tired before, I get exhausted now. Ironically, my migraines have calmed down a bit (KNOCK ON WOOD) the past couple months, but I have to nap for 2-4 hours on the days I exercise or even go to bed right after work.

    I have checked out some books on sleep problems and kept a diary for 2-3 weeks and have decided that maybe I do need to do a study after all. I wake up so many times a night it’s ridiculous some nights. I found one book that suggested putting pennies in a box and then putting them in another box every time you wake up. One night I had 9 pennies. These are just the times I KNOW I’m fully awake and not sleeping. I also keep the diary from a local sleep center that I’ll probably call for an appt. It seems that many people really do have problems with sleep and while I don’t fit the typical category of people with sleep apnea, etc – neither does my husband (we are both tall and thin) and he snores with the best of them – LOL – out on the couch! So I guess you never know until you find out.

    The reality is that many of the medicines we take both preventatively and to treat migraines can cause drowsiness. My PCP and I discussed this at my appt. But he is leaving any changes up to the neuro. Add in all of that stuff above (I know I have a post-migraine fatigue period of a day or so) and it makes matters that much worse, esp when other health factors are involved.

  • lara
    6 years ago

    Fatigue is the most debilitating of my symptoms aside from the pain. I have a strict sleep schedule and I get exercise by walking but still – the fatigue creeps up on you. When you combine that with medication like Topamax? Ugh. A total meltdown ensues at migraine onset. Plus, I get it through all phases of my migraine.

    I live in the Greater Seattle area and I have multiple triggers but one of them is the weather which means I get several migraines a month. I’m a more accurate weather predictor than the weatherperson.

  • Diana-Lee author
    6 years ago

    Fatigue really is debilitating. I honestly feel like it’s one symptom that is all too often completely overlooked.

  • Garangwyn
    6 years ago

    I suffered 2-3 migraines a week for a year while trying to maintain a full-time job, and the migraines lasted for 1-3 days each. The fatigue was constant. My weekends, if not laid out with a migraine, were spent trying to recover from the fatigue. All my former activities ceased; I quit having a social life; I quit going places at all; I couldn’t clean house, I couldn’t take care of my yard, I could barely get out to buy food (I am a single woman who at that time lived alone). I would buy a little food on the way home from work if I I could manage it. I was finally put on disability and lost my job, but the migraines have since improved dramatically. Being unable to rest when I needed to was probably the single most debilitating part of the whole problem, and although I am much improved now (after a year on disability), I am afraid of what will happen if I go back to work in a stressful work environment where I have no control over how much stimuli I am subjected to (lights, noise, stress, etc.) Yet I am not quite old enough to retire. My son, who finally came to live with me is ready to move out (and I’m ready for him to move out! lol) but my home and my yard have never recovered from the year + of neglect. And I am just now regaining some of my energy, but not enough to tackle all that needs to be done (and on a very limited income, I cannot afford to hire someone to help). My son? His work is seasonal and therefore his income is limited too — and he helps out some, but I don’t have the energy to nag him into doing something for me!

  • Diana-Lee author
    6 years ago

    That’s kind of how it is for me, too: On the rare occasions when I don’t have a Migraine, I’m recovering from one and exhausted.

    I’m so sorry your son isn’t more a help to you. That must be hard.

  • taralane
    6 years ago

    Your story sounds much like my own, except without the son. I am on disability, and close to retirement age numerically, but my migraines which have been over 15-20 a month for the last 10 years, have wreaked such havoc on my life and work that I long to get back to work if I only could! Fatigue from the constant pain is overwhelming to me even on the off day, like yesterday, when I woke up feeling well, with no morning migraine to start the day. I just could not get up and face anything that had to be done. The previous 7 weeks in bed with constant migraines had left me with no energy except keeping myself fed. I walked to the mailbox in my building complex 2x a week to pick up mail, and have been doing only the minimum amount of things I need to do to keep going. I have trouble with depression as well, and this much pain always sends me down into a slump, this one being a little lower than normal, but I am trying to get out of it bit by bit. I have not exercised in over 3 weeks, and just miss fresh air! I have always been an athletic person, and look at myself, and am disturbed at what the past 10 years has done to my strength and ability to care for myself.

    Go ahead and nag your son! He is young and has been living with you – some work around the house so you can be more comfortable is in order. Quid pro quo, as they say. I wish I had a son to do things I cannot do for myself at the moment.

    I also live in the Pacific Northwest, and the storms off the Pacific are quick to come in and we have had a long rainy season in Northern CA. This has exacerbated my migraines. I don’t need a weather report. I know when the barometric pressure is on the way down. We also have a lot of fog here, and when it rolls in at night, the pressure drops, and my sleeping schedule is totally interrupted. Anything at 30.02 or below and I’m in for a bad migraine. As it is now, I go to sleep at 2 or 3 in the morning and have a hard time getting up by 11:00 am.

    Good luck with your son!

  • 2mnyheadaches
    6 years ago

    The past few months I have had 14-15 migraines per month, I could not believe how fatigued I was all the time. Even though I kept my normal sleep schedule it was hard to do the things I have always done and it was so frustrating to not be able to do things that my family expects from me. My Dr added meloxicam to my medications which broke the constant headache cycle for me and my energy level has greatly increased. I hope my improvement continues but I try to take advantage of each day, knowing that it may not last.

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