fatigue syndrome, sometimes called CFS, 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 for at least 6 months is the main
Many people improve in a year or two and do not have a
relapse. Some people continue to have severe fatigue and other symptoms for
The disease is not well understood. Most experts now
believe that it is a separate illness with its own set of symptoms. But some
doctors do not believe this.
There are no tests for 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 combination of emotional and physical factors.
What causes CFS?
Doctors don't know what causes
CFS. Sometimes it begins after an illness like the flu, but there is no proof
of any connection. It's likely that a number of factors or triggers come
together to cause CFS.
What are the symptoms?
Extreme tiredness, or
fatigue, is the main symptom. If you have CFS:
You may feel exhausted all or much of the
You may have problems sleeping, or you may wake up feeling
tired or not rested.
It may be harder for you to think clearly, to
concentrate, and to remember things.
You may also have headaches,
muscle and joint pain, a sore throat, and tender glands in your neck or
Your symptoms may flare up after a mental or physical
activity that used to be no problem for you.
Depression is common with CFS, and it can make your other
symptoms worse. Antidepressant medicines can help you feel better.
How is CFS diagnosed?
There are no tests for CFS.
Doctors can diagnose it only by ruling out other possible causes of your
fatigue. Many other health problems can cause fatigue, and most people with
fatigue have something other than chronic fatigue syndrome.
How is it treated?
There is no treatment for CFS
itself, but many of its symptoms can be treated. A good relationship with your
doctor is important, 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
start getting regular gentle exercise.
Counseling and a gradual
increase in exercise help people who have CFS get better.
it may not be easy, keeping a good attitude really helps. Try not to get caught
in a cycle of frustration, anger, and depression. Learning to cope with your
symptoms and talking to others who have the same illness can help you keep a
Doctors do not know what causes
chronic fatigue syndrome (CFS). Some people develop it
after having a viral or bacterial infection, such as the flu, but there is no
evidence to prove this link. Other theories point to the
immune system, the nervous system, glands and
hormones, and family history. But again, there's not enough evidence to prove
The main symptom of
chronic fatigue syndrome (CFS) is a devastating
tiredness or exhaustion that has lasted at least 6 months and does not improve
much with rest. This fatigue also is so severe that it interferes with your
work, your play, and your social activities. The fatigue and other symptoms
described below may begin suddenly or they may develop gradually over weeks or
Other long-term symptoms include:
Forgetfulness, memory loss, confusion, or
that are different from other headaches you have had in the
Unrefreshing sleep (waking up feeling tired or not rested).
Feeling unwell after exercise or other physical activities.
Because CFS is not easily diagnosed, health experts have
established some rules to help them recognize the disease. To be diagnosed with
CFS, you must have fatigue and at least four of the symptoms listed above. At
least four of your symptoms must have started at the same time as or after your
fatigue began, and they must have lasted for at least 6 months.
But if you have symptoms of CFS, such as often feeling very tired for no clear reason, you may still get treatment even if you don't quite meet these criteria. For instance, your doctor may decide you need treatment even if you have had symptoms for less than 6 months.
Some people with CFS develop a
condition in which their heart rate increases and their blood pressure drops
when they stand or sit up from a reclining position. This is often described as
feeling "lightheaded" or feeling faint or dizzy. This condition is called
Depression is common and can make your other symptoms
worse. Antidepressant medicines can help you feel better.
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,
chronic fatigue syndrome (CFS) develops after an
illness such as
mononucleosis (mono) or
the flu, or after a period of unusual stress. But it may
also develop 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 CFS
because the diagnosis often is not clear for some time.
Symptoms are worse at the
Later, you may feel better for a time and then feel
worse again. Or your symptoms may disappear entirely. Many people improve in a
year or two and do not have a relapse. Some people continue to have severe
fatigue and other symptoms for many years.
Some people find the fatigue, pain, and thinking problems
caused by CFS greatly hamper their lives, but other people are not nearly as
Most people are still able to perform some of
their usual activities at home and work, but they often are unusually tired
after they do them. People often have to cut down on social and recreational
activities to save their energy for work and family.
have trouble doing most or all of their daily activities, including work and
the basic chores of daily living. They may have to carefully plan how to best
use their energy.
People who are most severely affected by CFS may
have difficulty getting out of bed and may require help with basic activities
such as dressing, eating, and bathing.
What Increases Your Risk
People who have
chronic fatigue syndrome (CFS) are generally 25 to 45
years of age. Women are more likely to have CFS.
CFS is rare in
children. It may occur in teenagers, especially young teenage girls. Unlike
adults, teenagers are more likely to develop CFS after having an illness such
When To Call a Doctor
It's important to talk to your
doctor about any symptoms you may have.
Call your doctor if
Severe fatigue that lasts longer than 2 weeks,
causes you to limit your usual activities, and does not improve with
Sleep problems (being unable to fall asleep or stay asleep,
tossing and turning, waking up feeling tired or not rested) that last for more
than 1 to 2 months.
Swelling in the glands in your neck or armpits
(without other signs of infection) that lasts for at least 2 weeks.
Severe fatigue along with frequent urination (especially at
night), extreme thirst, weight loss, or blurred vision. Fatigue that occurs
with some or all of these may be a symptom of undiagnosed
Headache that lasts longer than 2 weeks.
Watchful waiting refers to a period of time in which you are being
watched by your doctor but are not receiving treatment. It is also called
observation or surveillance. 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
CFS or another medical problem. But if your fatigue has not improved after
1 to 2 months of self-care, or if fatigue is persistent and limits your usual
activities, call your doctor.
If you have been diagnosed with CFS,
pay attention to any new symptoms and report them to your
doctor. Although CFS can cause a variety of symptoms, new symptoms could be
caused by another illness or medical condition that may need to be evaluated
Who to see
The following health professionals can evaluate
fatigue and other symptoms:
There are doctors who specialize in the treatment of CFS.
Get a recommendation from your family doctor or a local CFS support group
before making 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
Chronic fatigue syndrome (CFS) is hard to diagnose. Fatigue is an extremely common
problem, and it can have many other causes. CFS can be diagnosed only by ruling
out other conditions.
First, your doctor will take your
medical history and do a physical exam. Experts have
come up with a specific list of symptoms to decide whether a person has CFS.
Doctors use a variety of tests to rule out other conditions. These tests
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, because so little is known about the immune
system's connection to chronic fatigue syndrome.
chronic fatigue syndrome (CFS) focuses on making you
feel better so that you can resume a normal life. Simple measures you can take
at home—such as improving your sleep habits and getting gentle exercise—are
important parts of treatment. Talking with a counselor or psychologist has been
shown to be helpful for people who have CFS.
Although there is no cure for CFS, many of its symptoms do respond to
Pain relievers that you can buy
without a prescription, such as acetaminophen or ibuprofen, may help
relieve headaches, muscle and joint pain, and other physical symptoms. Narcotic
pain relievers, which require a prescription from a doctor, may
become addictive if they are used frequently. So they are typically prescribed
in the most severe cases on a short-term basis.
antidepressants and getting counseling can help
relieve your other symptoms, whether you have
depression or not. Antidepressants are used to improve
your mood, control your pain, and help you sleep. With CFS, treating both
physical and psychological factors is important.
There are many
unproven remedies, such as special diets or mineral
supplements, that some people recommend for treating CFS. There is no evidence
that any of these are effective.1
Home treatment is very
Adjusting your daily schedule to take advantage of times when you have more energy, improving your sleep
habits, and getting regular and gentle exercise can often help you feel better.
Beginning a graded exercise program, in which the level of exercise starts out
easy and gradually grows more challenging, should be part of your treatment.
Studies have shown that a carefully planned exercise program can help people
with CFS regain their strength and energy and feel better.1 Remember that if you have CFS, you will be able to do only
light exercise. Doing too much or increasing your level of exercise too quickly
can make your symptoms worse.
A type of counseling called
cognitive-behavioral therapy has been shown to help
people who have CFS feel less tired.1 It is counseling
that teaches people how to change the way they think and behave to cope more
successfully with their fatigue and other symptoms.
it's not easy, keeping a good attitude is a great benefit for people with CFS.
Your mind and body are connected and influence 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 your disease and 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. It's easy to get caught
in a cycle of frustration, anger, and depression. Learning to cope with your
symptoms will help you avoid that cycle.
Regular visits to your doctor every few months can help
track your progress and evaluate any changes in your symptoms that might
indicate that your fatigue is caused by something other than CFS.
Treatment if the condition gets worse
news about CFS is that it rarely gets worse over time. In some people, it goes
away in 1 or 2 years. Others have periods of relatively good health followed by
periods of severe symptoms and great difficulty. Relapses are not unusual.
Continue to see your doctor periodically to monitor changes in your
What to think about
Although the cause of
chronic fatigue syndrome (CFS) is not well understood,
the fatigue is real and can make day-to-day activities difficult. As you work
toward regaining your strength and energy, don't go too fast. Aim for a gradual
return to your previous level of activity.
Chronic fatigue syndrome (CFS) can be neither prevented nor cured. Home treatment and,
when appropriate, certain medicines can help control or reduce symptoms.
Home treatment is the most important
part of treating
chronic fatigue syndrome (CFS). If you have CFS, you
can take steps to control and sometimes relieve your symptoms:
Adjust your schedule to take advantage
of times when you feel more energetic and less tired. Keep a diary for a week
or so and record the times of day when you have energy and when you are tired.
If there is a pattern to how your energy level changes during the day, try to
plan your work, school, or other activities around that
Try not to do too much when you are feeling energetic. If
you do too much, you may become overtired, and it may take several days for you
Improve your sleep habits. Sleep problems may
contribute to your fatigue and other symptoms.
Go to bed only when you are sleepy, and get
up at the same time every day, regardless of whether you feel rested.
If you lie awake for longer than 15 minutes, get up, leave the
bedroom, and do something quiet until you feel sleepy again.
alcohol, caffeine, and tobacco before bed.
Keep the bedroom at a
comfortable temperature, and eliminate all sound and light disturbances.
Make sure your mattress provides good support. Use a neck support
pillow to keep your head and neck from moving too much when you
Take naps if you need to. Keep them short (20 to 60
minutes), and try not to take them late in the day or evening.
Get light, gentle exercise regularly. Stretching
is a good beginning exercise. Light aerobic exercise such as walking, swimming,
or riding a bicycle or stationary bike can also be helpful. You need to find a
balance between exercising enough to benefit from it and exercising so much
that you become overtired.
Try taking nonprescription pain medicines to
relieve muscle and joint pain and headaches caused by CFS. Medicines that may
be helpful include acetaminophen (such as Tylenol), ibuprofen (such as
Advil or Motrin), or naproxen (such as Aleve). Be safe with medicines. Read and follow all instructions on the label.
Join a support group. These groups can be a good source of information and tips
for managing your illness and a chance to share your frustrations and
problems with others who have CFS. Ask your doctor or contact a local hospital
for the location of a support group near you.
Eat a balanced diet that is low in fat and high in
carbohydrates and fiber.
Be patient, and keep in mind that consistent home treatment
usually helps relieve or control CFS symptoms. Your doctor may suggest
cognitive-behavioral therapy to help you with your home treatment.
Medicines do not cure
chronic fatigue syndrome (CFS): they only help relieve
symptoms. They may not greatly speed up your return to full activity. But when
medicines are used properly, they can help you feel better.
Over-the-counter medicines include:
Pain relievers and anti-inflammatory drugs:Over-the-counter drugs, including acetaminophen (for
example, Tylenol), ibuprofen (for example, Advil, Motrin), or naproxen (for example, Aleve), are used to treat frequent or severe joint and
muscle pain, headaches, and fevers. Be safe with medicines. Read and follow all instructions on the label.
Prescription medicines include:
Antidepressants:Antidepressants are prescribed by a doctor to ease depression and anxiety,
improve your ability to concentrate, help you sleep better, and decrease
fatigue and muscle pain.
Codeine, morphine, and meperidine (Demerol): These drugs are prescribed by a doctor for pain
that is not relieved by over-the-counter drugs. They generally are reserved for
the most severe cases. Because of the risk of addiction, they are used only on
a short-term basis.
What to think about
Some research has studied the
corticosteroids (such as hydrocortisone and
fludrocortisone) to treat chronic fatigue syndrome (CFS). Studies have shown
that these medicines do not work very well to treat CFS. And the side effects
can be serious. Unless corticosteroids can be shown to have a greater benefit
for people with CFS over a longer period of time, the side effects associated
with long-term corticosteroid therapy outweigh the benefits from their use in
Depression often becomes a part of
chronic fatigue syndrome and can make your symptoms worse. Like any medical
illness, depression needs to be treated. If you have CFS and are depressed,
tell your doctor how you feel. Antidepressants and counseling can help you
keep a good attitude, which has been shown to be a great benefit to people
who have CFS.
As with many conditions that
have no clear cause and no effective medical treatment, there are many
treatments outside of conventional medicine that some people recommend for
chronic fatigue syndrome (CFS). None have been shown
to be effective.
But there are safe nontraditional
therapies—acupuncture, yoga, or massage therapy, for example—that can relieve
pain and stress, ease muscle tension, help you feel better and healthier, and
improve your outlook and quality of life.
There are many unproven treatments for CFS. Some of the more popular ones include:
Large doses of vitamins or minerals. But taking too much of certain vitamins and minerals can
actually be harmful.
Diets that eliminate certain foods or
ingredients (such as yeast, sugar, or food additives) that some people believe
immune system. Because the exact role of the immune
system in CFS isn't well understood, there is no scientific basis for these
remedies. But if certain foods seem to make your symptoms worse, there is
no harm in avoiding them as long as you are eating a balanced diet.
Aloe vera juice.
Evening primrose oil.
Royal jelly (a bee product).
What to think about
None of these complementary
therapies have been proven effective in treating CFS, but some people have
reported feeling better after using them. If you have CFS and are thinking
about trying a complementary therapy, get the facts before you begin. Consider
these questions with your doctor:
Is it safe? Do not use
treatments that could harm you, such as unusual diets or excessive vitamin or
mineral supplements. (A daily multiple vitamin is okay. Try to avoid taking
more than 100% of the
recommended daily allowance for any vitamin or mineral
unless your doctor prescribes it.)
Is the product manufactured reliably? Vitamin and mineral supplements and herbal
products are not subject to the same regulations as medicines. Ingredients may
vary from one maker to another. Read the labels carefully and choose well-known
brands you trust.
Does it work? It may be
hard to tell whether a treatment is working. Keep in mind that when you get
better after treatment, the treatment may not be the reason for your
improvement. Symptoms of CFS often improve on their own, or the treatment may
be causing a
placebo effect, which makes you feel
How much does it cost? An expensive
treatment that may or may not help you may not be worth the high cost. Beware
of products or treatment providers who require a large financial investment up
front or a series of costly treatments.
Will it improve my general health? Even if complementary therapies are not
effective in treating CFS, some of them are safe and healthy habits that may
improve your general well-being and may be worth trying.
Avoid products that claim to have a "secret" ingredient or that claim
to cure CFS. Currently, there is no cure for 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.
The American College of Physicians (ACP) is
a national organization of internists. Doctors of internal medicine focus on
adult medicine and have had special study and training focusing on the
prevention and treatment of adult diseases. The ACP provides information for
patients and families on the organization's website, including information on
diseases and conditions, end-of-life care, women's issues, and immunizations.
The site also offers video news stories, health tips, special reports, and a
link to the ACP diabetes webpage.
Centers for Disease Control and Prevention (CDC) Chronic
Fatigue Syndrome Page
1600 Clifton Road
Atlanta, GA 30333
1-800-CDC-INFO (1-800-311-3435) (404) 639-3534
This Web site provides information about the diagnosis
and treatment of chronic fatigue syndrome. It also includes information to help
you find a support group for people with CFS. The site is maintained by the
National Center for Infectious Diseases of the Centers for Disease Control and
Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS)
Association of America
P.O. Box 220398
Charlotte, NC 28222-0398
The CFIDS Association of America works to build support
for people suffering from chronic fatigue and immune dysfunction syndrome (also
known as chronic fatigue syndrome). The organization offers educational
information and other resources to people with CFS, their family and friends,
support groups, caregivers, the general public, and health professionals.
Reid S, et al. (2011). Chronic fatigue syndrome, search date March 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
Bleijenberg G, Van Der Meer JWM (2012). Chronic fatigue syndrome. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 3519–3521. New York: McGraw-Hill.
Engleberg NC (2010). Chronic fatigue syndrome. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., pp. 1897–1904. Philadelphia: Churchill Livingstone Elsevier.
Sadock BJ, Sadock VA (2007). Chronic fatigue syndrome. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 652–657. Philadelphia: Lippincott Williams and Wilkins.
White PD, et al. (2011). Comparison of adaptive pacing therapy, cognitive behaviour
therapy, graded exercise therapy, and specialist medical care
for chronic fatigue syndrome (PACE): A randomised trial. Lancet, 377(9768): 823–826.
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Nancy Greenwald, MD - Physical Medicine and Rehabilitation
How this information was developed to help you make better health decisions.