Common symptoms in ME/CFS

Common symptoms in ME/CFS include post-exertional malaise, multiple types of fatigue, and a range of neurological, cardiovascular, energy metabolism and endocrine symptoms.

Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) is often referred to as ME/CFS as it is clear there are common onsets and symptoms shared by both the disease ME and the symptoms that define CFS.

Chronic Fatigue Syndrome

Common Symptoms in Chronic Fatigue Syndrome

Symptom	Mild to Severe Symptom %	Moderate to Severe Symptom %
Fatigue - persist or relapsing*	100	95
Significant reduction in activities*	100	100
Symptoms last over 6 months*	100	100
Post-exertional malaise	96	86
Memory & concentration probs	98	80
Unrefreshing sleep	99	92
Headaches - new or different	90	50
Muscle pain (myalgia)	96	73
Sore throat	81	31
Source: Jason et al. 2014

*Required symptom, can be mild

Jason et al. (2014) found these symptoms were the most common among people who met the Fukuda criteria, which are the symptoms normally used to diagnose in the US and UK.

Approximately 60% of people with Chronic Fatigue Syndrome also meet the criteria for M.E.

Symptom	Mild to Severe Symptom	Moderate or Severe Symptom
Fatigue - persist or relapsing*	100	95
Substantial reduction in activities*	100	100
Symptoms last over 6 months*	100	100
Post-exertional malaise	96	86
Memory & concentration difficulties	98	80
Unrefreshing sleep	99	92
New or different headaches	90	50
Muscle pain (myalgia)	96	73
Sore throat	81	31
Joint pain (arthralgia)	86	65
Lymph node pain	81	44

*Required symptom, can be mild

Myalgic Encephalomyelitis

Common Myalgic Encephalomyelitis Symptoms

Symptom	%
50% reduction in previous activity level	100(Required)
Post-exertional neuroimmune exhaustion	100(Required)
Fatigue - moderate or severe	80
Minimum exercise makes you tired	82(PENE)
Next-day soreness after mild activity	79
Physically drained/sick after mild activity	77
Dead, heavy feeling after start of exercise	73
Mentally tired after slightest effort	68
Unrefreshing sleep	82(Neuro)
Difficulty paying attention for long	77
Muscle pain (myalgia)	69
Sensitive to smells/foods/drugs/chemicals	67(Immune / GI / Urinary)
Flu-like symptoms	64
Irritable bowel problems	56
Feeling hot / cold for no reason	58(Ion transport / Metabolism)
Sources: Jason et al. 2016, Intl Consensus Criteria 2011

Myalgic Encephalomyelitis diagnosis requires more symptoms than Chronic Fatigue Syndrome diagnosis.

People with M.E. typically meet the CFS criteria as well, and were found to have more severe symptoms and reduced functioning overall.

Long list of symptoms

The Canadian Consensus Criteria lists these as known symptoms in Appendix 4.

Cognitive symptoms

Cognitive symptoms

• difficulties processing information
• concentration problems
• confusion
• difficulties with word retrieval
• word mix-ups
• short-term memory difficulties
• slowness in cognitive processes

Motor and balance

Motor and balance

• muscle weakness or paralysis
• poor balance, ataxia & tandem gait
• clumsiness & tendency to drop things
• difficulty in tandem gait
• atypical numbness or tingling

Sleep disturbances

Sleep disturbances

• hypersomnia or insomnia
• non-refreshing sleep

Symptom recognition

The DePaul Symptom Questionnaire can be used to assess symptoms of both M.E. and CFS. The Canadian Consensus Criteria (Appendix 4) also contains an extensive list of possible symptoms. The severity of illness and overall health can be assessed using the SF-36 health survey.

Notable studies

Castro-Marrero et al. 2017

Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Nationwide Population-Based Cohort Study

• 1757 Spanish subjects who met both the 1994 CDC/Fukuda definition and Canadian Consensus Criteria for CFS/ME. Table 2 gives prevelance of each ME/CFS symptom in the Canadian Consensus Criteria

Jason et al. 2016

Are Myalgic Encephalomyelitis and chronic fatigue syndrome different illnesses? A preliminary analysis.

• Myalgic Encephalomyelitis (International Consensus Criteria) symptoms are compared with symptoms of patients meeting the Chronic Fatigue Syndrome Fukuda criteria but not the M.E. criteria. Those meeting the M.E. criteria were also found to meet the CFS criteria, and to have more severe symptoms.

Jason et. al 2014

Examining case definition criteria for chronic fatigue syndrome and myalgic encephalomyelitis

• 236 patients completed the DePaul Symptom Questionnaire, rating the frequency and severity of 54 symptoms, compared to controls.

de Becker et al. 2010

A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome

• A study of 2073 patients complaining of chronic fatigue (CF) in Brussels. Table 1 and Table 2 show the how many patients had each symptom according to whether they met the Fukuda criteria, the Holmes criteria or had chronic fatigue without CFS.

1578 CFS patients fulfilled the Fukuda criteria (called the "CFS group") and 951 (60.3% of the CFS group) fulfilled the Holmes criteria. The Holmes definition was found to be better than the Fukuda at differentiated CFS patients from the patients with Chronic Fatigue without CFS.

See also

• Rare and uncommon symptoms
• DePaul Symptom Questionnaire
• SF-36 Health Survey
• CDC 2005 Symptom Inventory for CFS
• Chronic Fatigue Syndrome
  • CFS Fukuda criteria
• Myalgic Encephalomyelitis
  • Holmes criteria
  • Canadian Consensus Criteria
  • International Consensus Criteria
• Systemic Exertion Intolerance Disease

Learn more

• What is M.E? - Invest in M.E. Reseach

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

cognition Thought processes, including attention, reasoning, and memory.

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

See Centers for Disease Control and Prevention.

See ME/CFS.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.