Fibromyalgia patients have widespread pain in many parts of their body, particularly in parts of the spine. They have many tender points where firm pressing with a finger produces pain. These points are particularly likely to occur in the lower back, neck, shoulders, hips, hands, knees, chest wall and feet. In addition to feeling pain, the patients tend to be fatigued, wake unrefreshed from sleep and be very stiff in the morning. Some 25 per cent of these patients have less common complaints such as irritable bowel syndrome, headaches and distress. The general state of fibromyalgia can be a common but temporary state.An early-morning visit to one of the airports in London reveals the sad sight of hundreds of passengers off the red-eye specials from the east coast of the United States. They are tired, missing sleep, their biological clocks are set five hours behind, and they are irritable, anxious and stiff. They drag along looking like a mass migration of fibromyalgia patients. Most of the travellers will recover but, in the patients, it is a chronic state. It is ten times more common in women than men. Muscle and tissue taken from the tender points is vaguely abnormal but it is possible that these abnormalities result from inactivity and so are secondary to the pain. There is a suspicion that there is something wrong with their immune systems, and the condition sometimes occurs with frank disorders of the immune system such as rheumatoid arthritis.The response to treatment is disappointing. Some patients improve when given antidepressive drugs, which are known to have an analgesic action as well as an effect on depression. A vigorous fitness training regime improves some patients, as does specific muscle training. A three-week course of cognitive behaviour therapy improves the ability of some patients to cope with the miserable state.*49\219\2*

Migraine is far from being a trivial disorder, not least because the problems posed by migraine in the community and in the family can be enormous.
Migraine cost the National Health Service 2.8 million pounds in 1970, consisting of pharmaceutical costs of 1.6 million pounds, general practice expenses of 0.7 million pounds, and hospital investigations of 0.5 million pounds. Private treatments, and remedies bought privately, add further to this. In 1968-9, 295 000 man-days and 167 000 woman-days were lost from work on account of migraine. This, too, is an under-estimate since the calculation is based on health certificates which are issued only after three days off work, and most sufferers from migraine are often away for less than this at any one time. A recent survey showed that 21 per cent of Members of Parliament have migraine and that each one lost an average four man-days a year. Those who persist in working during an attack are likely to be less efficient, which also contributes to the problems caused by migraine.
Nearly everyone has a headache at some time in their lives but migraine with its special features affects only a minority. Estimates vary, depending on how migraine is defined, but it probably affects over 10 per cent of men and over 20 per cent of women. The reason as to why it should be commoner in women is not precisely known but this sex difference could be one more clue as to the cause.
The age at which migraine begins is also variable. It usually starts in adolescents and young adults but many of these have warnings as children of its likely development.

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