fatigue syndrome (ME/CFS) (say "my-AL-jik en-seh-fuh-loh-my-uh-LY-tus") is a condition that makes you feel so
tired that you can't do all of your normal, daily activities. There are other
symptoms too, but being very tired is the main
one. Some people have severe fatigue and other symptoms for
many years. Another name for this condition is systemic exertion intolerance disease.
ME/CFS is not well understood. Most experts now
believe that it is a separate illness with its own set of symptoms. But some
doctors don't believe this.
There are no tests for ME/CFS. Because
of this, many people have trouble accepting their disease or getting their
friends and family to do so. Having people who believe your diagnosis and
support you is very important. Having a doctor you can trust is critical.
Your tiredness is real. It's not "in your head." It is your
body's reaction to a mix of factors.
Doctors don't know what causes
ME/CFS. Sometimes it begins after a viral infection, but there is no proof
of any connection. It's likely that a number of factors or triggers come
together to cause ME/CFS.
Extreme tiredness, or
fatigue, is the main symptom. If you have ME/CFS:
Depression is common with ME/CFS, and it can make your other
There are no tests for ME/CFS.
Doctors may also look for other causes of your fatigue. Many other health problems can cause fatigue. Most people with
fatigue have something other than ME/CFS.
Here is one set of criteria (rules) that doctors use to diagnose ME/CFS:footnote 1
There is no treatment for ME/CFS
itself, but many of its symptoms can be treated. A good relationship with your
doctor is important. That's because the two of you will need to work together to find
a combination of medicines and behavior changes that will help you get better.
Some trial and error may be needed, because no single combination of
treatments works for everyone.
Home treatment is very important.
You may need to change your daily schedule, learn better sleep habits, and
use regular gentle movement or exercise to fight fatigue. Even at times when you have more energy, keep a low-key pace throughout each day. Rest often.
Living with ME/CFS can be as much a mental health challenge as it is a physical one. Take steps to avoid getting caught
in a cycle of frustration, anger, and depression. Learning to cope with your
symptoms and talking to others who have ME/CFS can help. So can working with a counselor.
Learning about ME/CFS:
Living with ME/CFS:
Health Tools help you make wise health decisions or take action to improve your health.
Doctors don't know what causes
ME/CFS. For many people, ME/CFS symptoms start after a viral illness. In some cases, ME/CFS seems to follow a major physical or emotional trauma or an exposure to toxins. But there is no single known cause of ME/CFS.
Other theories point to the
immune system, glands and hormones, and family history. But again, there's not enough evidence to prove
a solid connection.
ME/CFS symptoms usually start suddenly. But for some people, they develop gradually over weeks or months. Symptoms can change in a day, and from day to day. They tend to stop (remission) and then start again (relapse).
There is broad range of ME/CFS symptoms. But there is a core set of symptoms that affect nearly everyone with ME/CFS. These core symptoms are:
A person with ME/CFS may have one or more of these symptoms:
ME/CFS may also cause the following symptoms. Different people with ME/CFS have different combinations of:
Having depression along with ME/CFS is common and can make ME/CFS symptoms
causes symptoms that are the same as many other diseases, especially early on. For this reason, it can be diagnosed only after a thorough evaluation has ruled
out other conditions with similar symptoms.
In some cases,
ME/CFS develops after a flu-like
illness such as
mononucleosis (mono) or after a period of unusual stress. But it may
also occur without warning, even if you have not been sick.
fatigue may come upon you gradually or quite suddenly. Because fatigue can be
vague and can be caused by many things, you might not pay attention to the
problem for several weeks or months. It is hard to say what is normal with ME/CFS. That's
because the diagnosis often is not clear for some time.
Some people find the fatigue, pain, and thinking problems
caused by ME/CFS greatly hamper their lives. But other people are not nearly as
People who have
ME/CFS are generally 25 to 45
years of age. Women are more likely to have ME/CFS.
ME/CFS is rare in
children. It may occur in teens, especially young teenage girls. Unlike
adults, teens are more likely to develop ME/CFS after having a flu-like illness.
It's important to talk to your
doctor about any symptoms you may have.
Call your doctor if
Watchful waiting refers to a period of time in which you are being
watched by your doctor but are not getting treatment. A month or two of paying close attention to your
sleep habits, getting regular moderate exercise, trying to control stress, and
eating a balanced diet will take care of most cases of fatigue not caused by
ME/CFS or another medical problem. But if your fatigue has not improved after
1 to 2 months of self-care, or if fatigue won't go away and limits your usual
activities, call your doctor.
If you have been diagnosed with ME/CFS,
pay attention to any new symptoms and report them to your
doctor. Although ME/CFS can cause a variety of symptoms, new symptoms could be
caused by another illness or medical condition that may need to be evaluated
The following health professionals can evaluate
fatigue and other symptoms:
There are doctors who specialize in the treatment of ME/CFS.
Get a recommendation from your family doctor or a local ME/CFS support group
before you make an appointment with a specialist. It is always wise to start with
your family doctor. You may also be referred to a physiatrist, psychologist, or
To prepare for your appointment, see the topic Making the Most of Your Appointment.
ME/CFS is hard to diagnose. It is common to have normal test results when you have ME/CFS. Fatigue is an extremely common
problem, and it can have many other causes.
First, your doctor will ask you about past health and do a physical exam. Experts have
come up with a specific list of symptoms to decide whether a person has ME/CFS.
Doctors use a variety of tests to rule out other conditions. These tests
These are routine lab tests. Other tests may be done if
your symptoms, history, and physical exam suggest other possible problems.
These other tests may include:
Some doctors may order tests that check your
immune system. These can be expensive and generally
are done only in research settings. Also, it's hard to know what the
findings of these tests mean. That's because so little is known about the immune
system's connection to ME/CFS.
Since there is not yet a cure for ME/CFS, the key to living with ME/CFS is treating your symptoms.
Start by listing your worst symptoms-the ones that make it hardest to get through the day. With your doctor, focus first on treating those symptoms. Decide whether a specialist might be helpful for any of them.
The most common ME/CFS symptoms can also be the most treatable.
Good sleep habits can help improve the quality of your sleep. If you also try medicine for sleep, it's best to start on a low dose. Certain antidepressants help with sleep, mood, and chronic pain, so your doctor may suggest trying one.
Different kinds of pain can be treated in different ways. If one treatment doesn't work, you and your doctor can try another until you find what works best for you.
Do all you can to take charge of your fatigue level. Even when you have more energy, keep a low-key pace throughout each day.
Your doctor may recommend a program like graded exercise or cognitive-behavioral therapy as part of your treatment plan. More research is needed to better understand how well these treatments work for ME/CFS.
Living with ME/CFS can be as much a mental health challenge as it is a physical one. It's easy to get caught
in a cycle of frustration, anger, and depression.
You can expect your symptoms to come and go. For some people, certain things trigger long periods of worse symptoms. Visit your doctor every few months to help
track your symptoms and check for any need to change your treatment.
Get specialized care if you need it. For example:
There are many
unproven remedies, such as special diets or mineral
supplements, that some people recommend for treating ME/CFS. There is no evidence
that any of these are effective.
Your mind and body are connected and affect each other. Physical illnesses
can be made worse-or better-by your feelings and attitudes, and vice versa. Learn as much as you can about ME/CFS. Then work with your doctor to learn
ways to cope with your symptoms. Get emotional support from your health
professionals as well as from your family and friends.
ME/CFS can't be prevented or cured. But treatment can help control or reduce symptoms.
Home treatment is the most important
part of treating
can take steps to control and sometimes relieve your ME/CFS symptoms:
Try to be patient. Keep in mind that daily home treatment
usually helps relieve or control ME/CFS symptoms. Your doctor may suggest
cognitive-behavioral therapy to help you with your home treatment.
Medicines do not cure
ME/CFS. But they can help relieve
Over-the-counter medicines include:
Prescription medicines include:
For more information about treating some types of pain that may occur with ME/CFS, see:
Some research has studied the
corticosteroids (such as hydrocortisone and
fludrocortisone) to treat ME/CFS. Studies have shown
that these medicines don't work very well to treat ME/CFS. And the side effects
can be serious. Unless corticosteroids can be shown to have a greater benefit
for people with ME/CFS over a longer period of time, the side effects associated
with long-term corticosteroid therapy outweigh the benefits from their use in
most cases.footnote 3
Depression often becomes a part of
ME/CFS and can make your symptoms worse. Like any medical
illness, depression needs to be treated. If you have ME/CFS and feel depressed,
talk to your doctor and get treatment.
The best treatment for your ME/CFS is what makes you feel better. Along with daily self-care and the treatment you get from your doctor, you might find that other treatments help too.
There are safe nontraditional
treatments that can relieve
pain and stress, ease muscle tension, help you feel better and healthier, and
improve your outlook and quality of life.
Some popular complementary treatments include:
There are many unproven treatments for ME/CFS. Some of the more popular ones include:
None of these complementary
treatments have been proven effective in treating ME/CFS, but some people have
reported feeling better after using them. If you have ME/CFS and are thinking
about trying a complementary treatment, get the facts before you begin. Consider
these questions with your doctor:
Avoid products that claim to have a "secret" ingredient or that claim
to cure ME/CFS. Currently, there is no cure for ME/CFS. Any benefit reported as a
result of using a product is most likely due to improved symptom management,
chance, or, possibly, the illness running its course.
For more information, see the topic
CitationsInstitute of Medicine (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: Redefining an illness. Institute of Medicine. https://www.nap.edu/catalog/19012/beyond-myalgic-encephalomyelitischronic-fatigue-syndrome-redefining-an-illness. Accessed January 31, 2017.Brurberg L, et al. (2015). Exercise as treatment for patients with chronic fatigue syndrome. Cochrane Database of Systematic Reviews (2). http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003200.pub4/pdf/abstract. Accessed February 23, 2016.Cleare A, et al. (2015). Chronic fatigue syndrome. BMJ Clinical Evidence, published online September 28, 2015. http://clinicalevidence.bmj.com/x/pdf/clinical-evidence/en-gb/systematic-review/1101.pdf. Accessed February 23, 2016.Other Works ConsultedAgency for Healthcare Research and Quality (2014). Diagnosis and treatment of myalgic encephalomyelitis/chronic fatigue syndrome (Evidence Report/Technology Assessment No. 219). Rockville, MD: Agency for Healthcare Research and Quality. https://effectivehealthcare.ahrq.gov/ehc/products/586/2004/chronic-fatigue-report-150505.pdf. Accessed February 23, 2016.Bleijenberg G, ven der Meer JWM (2015). Chronic fatigue syndrome. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., CD chap. 464e. New York: McGraw-Hill Education.International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (2014). Chronic fatigue syndrome myalgic encephalomyelitis: A primer for clinical practitioners. Chicago, IL: IACFS/ME. http://www.iacfsme.org/portals/0/pdf/primerfinal3.pdf. Accessed February 23, 2016.Sharpe M, et al. (2015). Rehabilitative treatments for chronic fatigue syndrome: Long-term follow-up from the PACE trial. Lancet Psychiatry, 2(12): 1067-1074. DOI: 10.1016/S2215-0366(15)00317-X. Accessed February 26, 2016.
ByHealthwise StaffPrimary Medical ReviewerAnne C. Poinier, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerMartin J. Gabica, MD - Family Medicine
Current as ofMarch 23, 2017
Current as of:
March 23, 2017
Anne C. Poinier, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine
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Last modified on: 8 September 2017