Beyond Pain: Psychological Profiles in Chronic Migraine Compared With Fibromyalgia and Their Comorbidity

Chronic migraine (CM) and fibromyalgia (FM) are central sensitization pain conditions, with FM representing a prototypical nociplastic disorder. While both involve altered pain processing, their psychological profiles may differ, particularly in comorbid forms. In this cross-sectional multicenter study, 318 women were assessed: 97 with CM (M_age = 47.4 ± 12.9), 130 with FM (M_age = 49.8 ± 12.1), and 91 with CM+FM (M_age = 49.9 ± 9.9). Participants completed standardized self-reports of depression, anxiety, psychological distress, and defensive functioning. Women with CM showed more preserved affective regulation, whereas FM and CM+FM did not differ significantly. Cluster analysis identified three phenotypes: vulnerable (n = 73; 16% CM, 43% FM, 41% CM+FM), intermediate (n = 122; 32% CM, 43% FM, 25% CM+FM), and resilient (n = 76; 50% CM, 29% FM, 21% CM+FM). CM patients were mainly represented in the resilient cluster, while CM+FM patients were overrepresented in the vulnerable cluster. These findings indicate distinct psychological functioning in CM compared to FM and highlight greater psychological complexity in comorbid cases. Overall, results support a dimensional, transdiagnostic model of chronic pain, underscoring psychological functioning as a central factor for personalized care.