While some people are incapacitated by their symptoms of chronic fatigue syndrome, others can have less severe symptoms or episodes that come and go. By knowing all of the possible symptoms you can help your healthcare provider diagnose you properly. Tracking your symptoms can help you identify triggers. Perhaps most importantly, this awareness can help you see that you’re not the only one experiencing these problems.

Frequent Symptoms

In 2015, the National Academy of Medicine established that fatigue, post-exertional malaise, and sleep problems must be present in order to diagnose ME/CFS. In addition, either cognitive impairment (brain fog) or a worsening of symptoms while you are upright (orthostatic intolerance) must be noted.

Decreased Activity Level and Fatigue

You develop fatigue that was not present beforehand. You can’t do the activities you used to do at your job, at school, at home, or in your social life. You feel an unusual tiredness that can be severe and incapacitating.

Your fatigue is not relieved by sleep or rest. The fatigue is not due to strenuous physical labor. Your fatigue significantly lowers your ability to function normally in most situations. You have had this fatigue and drop in activity level for at least six months.

Post-Exertional Malaise

Post-exertional malaise (PEM) occurs after physical or mental activity that would not have resulted in feelings of tiredness or illness before you became sick.

An episode of PEM can range from mild—with extra fatigue, achiness, and brain fog—to completely disabling. The amount of exertion that can trigger it can be low, such as grocery shopping or taking a shower. You might describe it as how it feels to have mono or recover from a severe bout of influenza.

Sleep Problems

Unrefreshing sleep is a key symptom. You may wake up feeling like you haven’t slept at all, no matter how long you slept. You might also have insomnia, with difficulty falling asleep or staying asleep.

Cognitive Impairment

Problems with memory and thinking ability seen in chronic fatigue syndrome are commonly called brain fog. Experts believe there is a slowing of information processing that leads to this symptom. This is not a required symptom for a diagnosis, but either it or orthostatic intolerance must be present for a diagnosis to be made.

Orthostatic Intolerance

Short-term memory or concentration problems: These include losing your train of thought, forgetting what you were doing, or being unable to remember things you have heard or read. Word use and recall problems: This can include difficulty finding the right word or remembering the names of things or people. You might also have impaired speech. Impaired math and number ability: You may have a hard time calculating numbers or remembering number sequences or dates, for example. Spatial disorientation: This may involve becoming lost easily or not remembering how to get somewhere familiar. Difficulty multitasking not previously experienced

Orthostatic intolerance means that you have a worsening of your symptoms when you are standing or sitting upright. You might feel lightheaded, weak, or dizzy. You can have symptoms that make you think you are about to faint, such as blurred vision or seeing spots before your eyes. Again, you must have either this symptom or brain fog to meet the diagnostic criteria.

Pain

Pain is not a required symptom for diagnosis, but it is common in people with chronic fatigue syndrome. You may feel muscle aches, joint pain, or new or worsening headaches. Your pain is not caused by an injury. Here are some of the types of pain and changes in sensation that people report:

Pain amplification (hyperalgesia) Pain from light touch, brushing against the skin, and/or temperature (allodynia) New or worsening headaches Morning stiffness Earache Numbness, tingling and/or burning sensations in the face or extremities (paresthesia) Chest pains Jaw pain (possibly TMJ, as an overlapping condition)

Flu-Like Symptoms

You may feel like you are sick all of the time or symptoms may recur frequently. Flu-like symptoms are common, but not everyone has them and they are not required for a diagnosis. They include:

Sore throat Tender lymph nodes Low-grade fever or low body temperature, including chills, night sweats, or excessive sweating Chronic cough Nausea or digestive problems

Sensitivities and Intolerances

You can have changes in what you can tolerate. These symptoms are not experienced by everyone and are not required for a diagnosis.

New or worsening allergies Sensitivities to noise, light, odors, foods, chemicals, or medications Sensitivity to heat and/or cold, causing symptoms to be worse Alcohol intolerance Sensory overload

Rare Symptoms

There are many symptoms that people with ME/CFS experience that are not universal or required for a diagnosis. They may be due to overlapping conditions.

General Symptoms

Visual disturbances (blurring, light sensitivity, eye pain, worsening vision, dry eyes)Dry mouth and eyes (sicca syndrome)RashesUnexplained weight changesMuscle twitchingSeizuresRecurrent infectionsFrequent canker sores

Psychological Symptoms

IrritabilityAnxietyPanic attacksPersonality changesMood swings

Cardiovascular and Respiratory Symptoms

A feeling of an irregular heartbeat Shortness of breath Frequent, hard to treat respiratory infections

Complications

As in any chronic illness, it is very common for people with chronic fatigue syndrome to experience depression, stress, and anxiety. While chronic fatigue syndrome is not a psychological condition, it is debilitating.

Tinnitus (ringing in the ears) Premenstrual syndrome (PMS) Endometriosis Depression Irritable bowel syndrome (IBS)

Good days or bad days can be unpredictable. You may experience ongoing challenges in your education, career, and personal life, as you work to balance how you feel about your obligations and desires. Many with ME/CFS describe feeling demoralized or even, at times, hopeless.

When to See a Healthcare Provider

You should see your healthcare provider if any of your symptoms are incapacitating or severe. The symptoms of ME/CFS are shared with many other conditions, some of which may require monitoring or immediate treatment.

If your symptoms are generally mild and fluctuating, you may question your need for an evaluation. Even if your symptoms are severe, you may have friends or family members who think you are exaggerating and don’t understand what you are experiencing. But chronic fatigue syndrome is more than just being tired—it’s feeling sick.

When your symptoms last for more than two weeks, continue to get worse, or if you have a pattern of recurrences (even if you returned to feeling normal between episodes), it’s time to make an appointment.

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While the diagnosis of ME/CFS won’t be made until you have the symptoms for more than six months, you shouldn’t delay seeking care and assessment. ME/CFS is diagnosed by symptoms and excluding other conditions. You may discover your symptoms are due to a condition that has an effective treatment available.

Chronic fatigue syndrome is often misunderstood, even by some healthcare providers. You may need to be persistent to ensure your symptoms get appropriate attention. 

Ongoing fatigue lasting at least six monthsExercise intoleranceUnrefreshing sleep

However, symptoms vary from person to person and many other symptoms are often attributed to ME/CFS, so it’s important to keep a log of what you’re experiencing to help yourself and your healthcare provider identify potential triggers.