Fibromyalgia phenotypes with and without chronic migraine: functional impact, quality of life, and reflective functioning

Background. Fibromyalgia (FM) is a complex chronic pain condition characterised by significant functional impairment and reduced quality of life. In clinical practice, it often co-occurs with other pain conditions, such as chronic migraine (CM). However, the relationship between CM and FM is not fully delineated, and potential areas of overlap require further investigation. Clarifying this relationship may provide useful information for diagnosis, management, and the conceptualisation of FM. Objective. To compare FM patients with and without CM (FibroMig) in functional impact, health-related quality of life (HRQoL), and reflective functioning, and to examine whether CM contributes to a distinct clinical profile within FM. Methods. A total of 205 patients (116 FM; 89 FibroMig) and 106 healthy controls (HC) completed the Fibromyalgia Impact Questionnaire-Revised (FIQR), the Short Form Health Survey (SF-12), and the Reflective Functioning Questionnaire (RFQ). Group differences were analysed using ANOVA and post-hoc tests. Results. FIQ-R scores did not differ between FM and FibroMig, indicating similar FM-related impairment. HRQoL differences emerged: FibroMig patients had lower SF-12 physical scores than FM (p=.04), and both groups scored lower than HC on physical and mental components (p=0.001). For reflective functioning, only RFQ–Uncertainty differed, with FibroMig showing greater hypomentalisation than HC (p=0.009); FM and FibroMig did not differ. Conclusion. FM patients with and without CM display similar functional and reflective functioning profiles, although FibroMig patients report greater physical impairment. These findings support considering CM as a clinical expression within the FM phenotype rather than a separate condition.