What Are The 7 Symptoms Of Chronic Fatigue Syndrome? Beyond Just Feeling Tired


Introduction Chronic fatigue syndrome, also known as myalgic encephalomyelitis or ME/CFS, is a complex illness characterized by long-term fatigue and other symptoms that limit functioning and quality of life. Getting an accurate diagnosis involves recognizing several primary symptoms outside of fatigue itself.

Let’s discuss what chronic fatigue syndrome is, the 7 core symptoms, common causes, and how it is managed.

What Is Chronic Fatigue Syndrome?

Chronic fatigue syndrome is a chronic condition characterized by extreme, unexplained fatigue lasting 6 months or longer that is not resolved by rest or sleep.

Chronic Fatigue Syndrome

The fatigue worsens with physical or mental activity but is not due to ongoing overexertion. Other key symptoms include widespread pain, cognitive

7 Symptoms Of Chronic Fatigue Syndrome

1. Persistent Fatigue

Exhaustion and lack of energy are the central symptoms of CFS. The fatigue significantly limits activity levels and doesn’t resolve with sleep or rest.

Patients describe fatigue as an overwhelming feeling of tiredness that fails to improve with rest. It may feel like you have the flu, muscle weakness, or “hit a wall” during basic tasks. 

2. Post-Exertional Malaise  

This refers to an increase in symptoms following physical, cognitive, or emotional exertion. Simple daily activities like grocery shopping may be followed by a crash of worsening fatigue, brain fog, pain, and other CFS symptoms. Just a minor effort may trigger symptom flares lasting hours or days.

3. Sleep Problems

Unrefreshing sleep is common. Many patients have insomnia and frequent sleep disruptions. But some may sleep excessively long without feeling restored.

Sleep problems exacerbate fatigue and difficulty concentrating during the day. Specific issues include light sleep, vivid dreams, waking repeatedly, and sleep phase shifting.

4. Cognitive Impairment

Called “brain fog”, problems with memory, concentration, processing speed, word recall, and focus are common cognitive symptoms.

Mental exhaustion and difficulty thinking clearly worsen with physical overexertion. Patients may struggle to absorb new information or follow conversations.

5. Orthostatic Intolerance  

Orthostatic intolerance involves symptoms that worsen when sitting or standing upright and improve when laying down.

Upon standing, patients may feel lightheaded, dizzy, weak, or faint. Heart palpitations, tremor, and shortness of breath frequently accompany orthostasis.

6. Pain

Widespread muscle aches, joint pain, headaches, and sore throats are often reported. Pain can occur anywhere but commonly affects the neck, shoulders, back, and hips.

For some patients, pain is one of the most debilitating CFS symptoms limiting activity tolerance.

7. Flu-Like Symptoms 

Many CFS patients experience sore throats, tender lymph nodes, chills, night sweats, and flu-like symptoms. While not present all the time, these symptoms tend to periodically flare up even without an active infection. Fevers are not common in CFS except during initial onset.

While not every individual has all symptoms, the presence of severe fatigue plus some combination of these other issues supports a CFS diagnosis. Paying attention to all symptoms provides clues for effective management.

What Are The Causes Of Chronic Fatigue Syndrome?

The exact causes are unknown but likely involve multiple factors like:

  • Viral infections – Past Epstein-Barr virus infection may be a trigger.
  • Immune dysfunction – Chronic low-grade inflammation, increased cytokines.
  • Mitochondrial dysfunction – Reduced energy production in cells.
  • Autonomic nervous system abnormalities – Dysregulation of the nervous system.
  • Neuroendocrine disruption – Altered HPA axis, cortisol, serotonin.
  • Genetic susceptibility – Gene variants that impact immune and nervous systems.

Research continues on definitive causes, which are likely a combination of these and other factors disrupting normal homeostasis.

How Is Chronic Fatigue Syndrome Treated?

There is no single cure or approved treatment for ME/CFS. Management is symptomatic, focusing on:

  • Activity pacing – Balancing rest and activity to avoid post-exertional malaise.
  • Stress reduction – Relaxation techniques, counseling, massage, yoga.
  • Treating pain – Over-the-counter analgesics, medical marijuana.
  • Energy management – Allowing adequate rest periods. Prioritizing tasks.
  • Managing sleep issuesSleep hygiene, cognitive behavioral therapy, medications.
  • Antidepressants or stimulants – For comorbid depression or alertness.
  • Graded exercise – Supervised mild increasing exercise may help over time.
  • Healthy diet – Nutrient-dense anti-inflammatory Mediterranean style diet.
  • Orthostatic intolerance management – Hydration, salt, compression garments.

The goal is to improve daily functioning and ease challenging symptoms through a combination of lifestyle adjustments, self-care, and medical therapies tailored to each patient.


Chronic fatigue syndrome is characterized by multiple debilitating symptoms with long-term fatigue as the central feature. Recognizing additional symptoms like post-exertional exacerbation, cognitive dysfunction, unrefreshing sleep, pain, and dizziness upon standing can help patients with accurate diagnosis and management.

While not fully curable, symptom improvement is possible through managing activity levels, addressing any sleep disorders, relieving pain, and supporting overall wellbeing holistically.


1. Is chronic fatigue syndrome the same as fibromyalgia? 

While they share some overlapping symptoms, CFS and fibromyalgia are distinct chronic conditions that often require different treatment approaches. However, some patients may have both.

2. Do symptoms usually fluctuate with CFS?

Yes, most patients experience symptom flares and remissions over time rather than steady symptoms. Tracking trends provides insight for prevention and pacing.

3. Are any tests used to diagnose CFS?

No definitive diagnostic lab test exists yet. Testing helps rule out other causes with similar symptoms. Diagnosis is based on meeting specific symptom criteria.

4. What causes the extreme fatigue in CFS? 

The exact mechanisms behind CFS fatigue remain unknown. Likely a complex interplay between dysfunctional brain signaling, immune dysregulation, nervous system impairment, genetics, hormones, etc.

5. Can symptoms ever resolve with CFS?

Symptom improvement and remission is possible, especially with early diagnosis and proper management. But CFS/ME is a chronic condition for most patients with periods of flares and improvement.

Dr. Jun Ren is a dedicated and experienced registered dietitian and nutritionist who is committed to helping people achieve their health goals through personalized nutrition plans. With a passion for promoting healthy eating habits and preventing chronic diseases, Dr. Ren has been able to assist numerous clients in improving their overall quality of life.

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