What is FND? How does it link to migraine?

Migraine is a long-term, painful health condition that affects around one in seven people. Over a billion people worldwide get migraine, and over 10 million in the UK. As we know, migraine is more than just a headache and can have other symptoms, the most common being light and sound sensitivity, nausea, vomiting, and aura. However, many people also experience dizziness, vertigo, tinnitus and temporary paralysis. Some of these symptoms can also occur with Functional Neurological Disorder (FND). 

What is Functional Neurological Disorder (FND)? 

FND describes a problem with how the brain receives and sends information to the rest of the body. The symptoms of FND differ to migraine, typically involving:  

• arm and leg weakness,  
• seizures,  
• vision and speech issues.  

There are also a number of common associated conditions that can occur alongside FND such as chronic pain, persistent postural perceptual dizziness (PPPD), as well as migraine. The symptoms for these associated conditions can often be perceived as FND symptoms. NHS Inform and FND Action have some very useful information on symptoms and common associated conditions. These associated symptoms are not directly caused by FND but can often occur alongside it. 

Can people have both migraine and FND? 

Some people with FND may also have migraine as an associated condition, this can sometimes make it difficult to determine if some of the symptoms such as vision and speech issues are due to the FND or migraine. It is important to treat each condition separately. A small study caried out by St George University hospital showed that managing and reducing migraine in patients with FND resulted in improved control of the symptoms. Inadequate treatment of migraine negatively affected FND symptoms. Despite this, further research is needed to understand the effect treating migraine has on FND.  

Treatments for each condition 

The treatment used to help and manage FND is rehabilitation therapy consisting of exercises which help to improve a person’s ability to carry out day-to-day tasks. Rehabilitation is designed to help retrain the brain, which some people find helpful, while others find that their FND symptoms continue despite having treatment. 

Usually, effective management of migraine requires a suitable acute treatment to take at the at the time of an attack starting; this can be pain relief such as paracetamol, ibuprofen and triptan medications. For frequent migraine, usually 4 or more a month, an effective preventive medication may be used to help reduce the frequency and severity of the migraine to a more manageable level. You can find out more about preventive medications, which aim to make you less sensitive to triggers and less likely to have attacks develop. You can discuss the options with your doctor. Often, GPs will prescribe betablockers (e.g. propranolol), tricyclics (e.g. amitriptyline, nortriptyline) or topiramate, and increasing the doses slowly reduces the chances of side effects. However, if you are unable to tolerate the required dose, even with slow increases, your doctor may switch to another.  

Having adequate treatment to manage your migraine, may help your FND symptoms and it is important to discuss this with your GP or healthcare professional further if you feel your migraine is impacting your FND. 

You might want to consider keeping a diary of symptoms to bring with you to any appointments.