Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Diagnosis

There is no single test that confirms a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Diagnosis is based on symptoms, medical history, and ruling out other conditions that can cause similar problems.

Symptoms of ME/CFS often overlap with many other health conditions, so your healthcare provider may evaluate for the following:

Sleep disorders
Fatigue may result from sleep-related conditions. A sleep study can help identify problems such as obstructive sleep apnea, restless legs syndrome, or insomnia.

Other medical conditions
Fatigue is a common symptom in several medical illnesses, including anemia, diabetes, and underactive thyroid. Blood tests may be ordered to look for these and other possible causes.

Mental health conditions
Fatigue can also be linked to mental health issues such as depression and anxiety. A mental health professional may help determine whether these conditions are contributing to symptoms.

Many people with ME/CFS also have other conditions at the same time, including sleep disorders, irritable bowel syndrome, or fibromyalgia. Due to significant overlap in symptoms, some researchers believe ME/CFS and fibromyalgia may represent different expressions of a similar underlying condition.

Diagnostic criteria
Guidelines from the United States Institute of Medicine define fatigue related to ME/CFS as fatigue that:

• Is severe enough to interfere with daily activities previously performed before illness

• Has a new or clearly defined onset

• Is not substantially improved by rest

• Becomes worse after physical, mental, or emotional exertion

In addition to fatigue, at least one of the following symptoms must be present:

• Problems with memory, concentration, or focus

• Dizziness that worsens when moving from lying or sitting to standing

These symptoms must last for at least six months and be present at least half of the time, with moderate to severe intensity.

Treatment

There is no cure for myalgic encephalomyelitis/chronic fatigue syndrome. Treatment focuses on managing symptoms and improving quality of life. The most disabling symptoms are usually addressed first.

Medications
Certain symptoms related to ME/CFS may improve with medication.

Pain
If over-the-counter pain relievers such as ibuprofen or naproxen are not effective, prescription medicines sometimes used for fibromyalgia may be considered. These may include pregabalin, duloxetine, amitriptyline, or gabapentin.

Orthostatic intolerance
Some people, especially adolescents, feel lightheaded or nauseated when standing or sitting upright. Medications that regulate heart rate or blood pressure may help reduce these symptoms.

Depression
Living with a long-term condition like ME/CFS increases the risk of depression. Treating depression may improve coping ability. Low doses of certain antidepressants may also help with sleep and pain symptoms.

Pacing for post-exertional malaise

People with ME/CFS often experience a worsening of symptoms after physical, mental, or emotional activity. This is called post-exertional malaise. It usually begins within 12 to 24 hours after exertion and can last for days or even weeks.

Managing activity levels is essential. The goal is to stay active without triggering symptom flare-ups, a strategy known as pacing.

Pacing focuses on reducing post-exertional malaise rather than returning to pre-illness activity levels. As symptoms improve, some people may gradually tolerate more activity without worsening symptoms.

Keeping a daily record of activities and symptoms may help identify personal limits and prevent overexertion.

Addressing sleep problems

Poor sleep can worsen many ME/CFS symptoms. Your healthcare team may recommend lifestyle changes such as avoiding caffeine, adjusting sleep schedules, or improving bedtime habits.

If sleep apnea is present, treatment may involve using a device that delivers air pressure through a mask during sleep to improve breathing and sleep quality.