COURSE · PART 3 · MODULE 11
Module 11: Pain, Migraine, Fatigue, and Sleep
Pain, migraine, fatigue and poor sleep can each be disabling. They can also amplify one another. This module gives each problem its own short page before bringing the pattern together.
What this module teaches
- Pain is common alongside FND, but it may have several causes and deserves its own assessment.
- Migraine is a neurological disorder that can coexist with and sometimes trigger FND symptoms.
- Fatigue is not laziness. Its causes can include FND, sleep loss, pain, medication and other medical conditions.
- Post-activity worsening describes a pattern; it does not by itself establish FND, ME/CFS or another diagnosis.
- Sleep complaints and sleep disorders are not the same thing. Treatable disorders should not be missed.
- When symptoms interact, change one part of the loop at a manageable dose. [1][2][3][4]
Pages
- Chronic Pain
- Migraine
- Fatigue and Post-Activity Worsening
- Sleep Problems and Sleep Disorders
- When Pain, Migraine, Fatigue, and Sleep Interact
The fifth page is a practical map for combined flares. It avoids repeating the full interaction loop on four separate pages.
Inside each page
For the Person With FND · For Family, Friends, and Other Supporters · For Clinicians and the Care Team · Research and Sources
Related reference: Common Co-occurring Conditions.
Research and Sources
Evidence is uneven across these symptoms. The pain and sleep sources are systematic reviews; the migraine source is a focused review; the pacing source concerns ME/CFS rather than FND and is used only to show uncertainty. [1][2][3][4]
| Citation | Figure | Full citation |
|---|---|---|
| [1] | — | Steinruecke M, Mason I, Keen M, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2024;95(9):874–885. FND-CIT-0015. https://doi.org/10.1136/jnnp-2023-332810 |
| [2] | — | Stone J, Coebergh J, Khoja L, et al. Migraine and functional neurological disorder (FND)—a review of comorbidity and potential overlap. Brain Communications. 2025;7(4):fcaf288. FND-CIT-0049. https://doi.org/10.1093/braincomms/fcaf288 |
| [3] | — | Sanal-Hayes NEM, McLaughlin M, Hayes LD, et al. A scoping review of “pacing” for management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): lessons learned for the long COVID pandemic. Journal of Translational Medicine. 2023;21:720. FND-CIT-0066. https://doi.org/10.1186/s12967-023-04587-5 |
| [4] | — | Kannan S, Dutta A, Das A. Sleep disorders in functional neurological disorder—a systematic review and meta-analysis. Neurological Sciences. 2025;46(4):1573–1580. FND-CIT-0073. https://doi.org/10.1007/s10072-024-07931-9 |
This overview still needs lived-experience, pain, headache, sleep, rehabilitation and accessibility review.
Plain-language draft and research package prepared: September 5, 2026 · Clinical review pending