Are My Symptoms Multiple Sclerosis or Fibromyalgia?

Q.

I suffer from tremors especially in my hands - are these known symptoms of FMS? I also suffer from what I think is vertigo, and if I close my eyes I feel like I am going to fall. Most people say this (combined with my other symptoms) is more like multiple sclerosis, but I've had four spinal MRIs (NO brain scans done) and they came out clear. My GP thinks it's FMS only because I gave him the info on it! Can you clear up any of this at all for me?

A.

Muscle tremors seem to be a known symptom of fibromyalgia syndrome, ranging from hand and head tremors to full body muscle tremors and weakness. There are some medications, including those used for restless leg syndrome or Parkinson’s disease, which may help.

People with fibromyalgia syndrome also report vertigo and dizziness as part of the disorder. When the vertigo symptoms have eased, there are a number of exercises that could help the vertigo - these are known as vestibular rehabilitation exercises. Try sitting down slowly looking in all directions, then slowly moving the head in all directions, first with eyes open and then with eyes closed. Repeat standing up. Try slowly changing position from sitting to standing or lying, and walking around and climbing stairs or slopes, first with open eyes and then (carefully) with closed eyes. Games that involve aiming and crouching (such as bowling), or catching and throwing may also help.

Some people with fibromyalgia also have hypoglycaemia (sometimes known as fibroglycaemia), or low blood sugar, which can tremors, dizziness and feelings of weakness. This is when the hormones produced by the pancreas, called insulin and glucagons, do not control the blood sugar properly and allow levels to fall to low, and it can be a reaction to a high sugar meal. This can be helped by eating smaller regular meals interspersed with healthy snacks (perhaps three small meals and three snacks, rather than three large meals), eating more complex carbohydrates (wholemeal bread, wholemeal pasta, brown rice and potatoes) and not missing meals.

Too much caffeine, in coffee and soft drinks, can cause or worsen a tremor, and cutting back on these, or replacing them with decaffeinated versions, may help.

Some medications for fibromyalgia syndrome can cause tremors as a side effect. These include the antidepressants bupropion, paroxetine and sertraline, the painkiller tramadol, the antiepileptic pregabalin and the muscle relaxant orphenadrine.

Dizziness and vertigo can also be a side effect of some medications as well, such as tramadol, pregabalin, bupropion, the antiepileptic gabapentin, the antidepressant trazodone, muscle relaxants and some of the older antidepressant drugs. These symptoms could also be caused by an undiagnosed ear infection.

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