Reviewed by: HU Medical Review Board | Last review date: December 2019

Before, during, and even after a migraine attack, several people living with migraine report an overall lack of energy. For some, the tired feeling is a disabling fatigue that gets in the way of daily activities and reduces overall quality of life.

What is fatigue?

Fatigue can be hard to describe, but you know when you have it. It is a general feeling of tiredness or lack of energy. It differs from being sleepy or drowsy because it’s not necessarily a feeling of needing to sleep. Fatigue is more of a deep exhaustion and lack of motivation.1

Fatigue can be a normal and reasonable response to stress or physical activity, or even illness. But, when it starts to interfere with everyday activities and quality of life or doesn’t go away with sleep and nutrition, there may be something more to the fatigue.

In the 2018 Migraine In America survey, 7 percent of 4,356 respondents reported “chronic fatigue” as an additional health condition. As many as 79 percent of respondents listed fatigue as a top migraine symptom just below head pain, sensitivity to light, difficulty concentrating, sensitivity to sound, and brain fog.

What is chronic fatigue syndrome (CFS)?

The Centers for Disease Control and Prevention consider it chronic fatigue syndrome (CFS) when the tiredness is:

  • Not due to activity
  • Not relieved by rest
  • A relatively new symptom and not a lifelong condition
  • Causes a significant reduction in previous levels of activities2

For a diagnosis of CFS, three main symptoms must be present, including:2

  • Significantly lower ability to do activities that were easily done before the illness for 6 months or longer
  • Worsening of CFS symptoms after physical or mental activity that would have typically not caused symptoms before the illness
  • Sleep disturbances

At least 1 of 2 other symptoms must be present as well: either memory/cognitive problems or a worsening of symptoms when standing up.2

Many health conditions may cause fatigue. It is estimated that 67 percent of people living with migraine also meet the criteria for CFS.3 The overlap of symptoms is something to keep in mind. When it strikes as a symptom of a migraine attack, it can make it very difficult to perform normal activities. Often, fatigue does not go away with the pain. The person living with migraine may experience fatigue for days following a migraine episode.

Why does it occur with migraine?

When the fatigue occurs after a migraine attack, it is called “postdrome.”4Postdrome is the group of symptoms that can happen after the actual pain of the migraine attack has gone, but it is still part of the migraine. It can include fatigue, nausea, dizziness, body aches, and trouble concentrating.4

It is not known why postdrome and its symptoms happen.4 The physiological changes that occur during the pain of the migraine itself can persist, which may cause the postdrome.

How is it treated?

If you are experiencing fatigue with migraine, talk with your doctor. Your doctor will ask you questions about your migraine symptoms, how often they occur, how severe they are, and how long they last. It may help to keep a migraine journal to record information on your symptoms, including migraine fatigue. The triggers for your migraine attacks may be the same for fatigue or prodrome, and reducing your exposure to these triggers may help reduce fatigue.

For some people, stress reduction techniques, regular exercise, and having a sleep/wake routine can help reduce fatigue.4 Each person is different, and talking with your doctor about your symptoms can help them work with you to find the appropriate treatment for you.

Tracking your migraine symptoms

Keeping a record of your migraine symptoms may help you figure out patterns and triggers to your attacks. It may be helpful to record such things as:

  • When and where your pain or symptoms start
  • Whether the pain spreads to your entire head or neck
  • How well and how quickly acute treatment helps reduce the pain or other symptoms
  • How long your pain or symptoms last
  • Whether you experience other symptoms such as vision changes, nausea, or light sensitivity

Personal experiences

Migraine.com advocates frequently write about their experiences with fatigue. The spoon theory is a popular way to explain the difference between the energy available for someone living with migraine compared to someone without a chronic disease. This migraine lingo can include discussing the challenge of managing spoons or one’s capacity to complete activities with migraine fatigue. Even though fatigue is a common symptom for many people living with migraine, attempting to get extra sleep isn’t always as easy as it sounds since insomnia can be a common side effect of the migraine pain. People with migraine share feelings of running on empty, as this disease can drain the life out of you. The Migraine.com community has also shared their tips on how to manage fatigue.

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