Health Guide

Chronic fatigue syndrome

What is it?

Chronic fatigue (fuh-TEEG) syndrome (CFS) is a long term illness that can be hard to diagnose. It is also called "chronic fatigue and immune-dysfunction syndrome (CFIDS)." The main symptom of CFS is extreme tiredness (fatigue) that may make it hard or impossible to do everyday tasks. Some people with CFS cannot work and some cannot even get out of bed at times. CFS may also cause many other symptoms. There is no cure for CFS. However, you may decrease some symptoms with treatment and lifestyle changes.


It is not known what causes CFS. It may be caused by problems with your immune (i-MUN) system. The immune system is the part of your body that fights infection (in-FEK-shun). Some people have their first CFS symptoms after having an infection, such as a cold or the flu. Or some people have their first CFS symptoms after a very stressful time in their lives. It is likely that more than one thing triggers (starts) CFS. CFS may run in families. It is not thought to be contagious (kon-TAY-jus) (spread through person-to-person contact).

Signs and Symptoms:

Symptoms of CFS may change from day to day. These symptoms can range from mild to severe (very bad). CFS can start suddenly or the symptoms may come on slowly. The symptoms may come and go or stay for months to years. Your symptoms may get worse during the first six months of your illness and then may stay about the same. The following are some common signs and symptoms of CFS:

  • Fatigue and discomfort.
  • Abdominal (belly) discomfort or digestive (deye-JES-tiv) problems, such as nausea (upset stomach) or diarrhea (loose BMs).
  • You may have an increase or decrease in your weight.
  • Feeling very tired for no reason that you know of and the feeling does not go away after rest.
  • Fatigue that lasts more than 24 hours after exercise or hard activity.
  • Joint pain. Joints are the places in your body where two bones meet.
  • Muscle aches or weakness.
  • Sleeping a lot or having trouble falling or staying asleep.
  • "Flu-like" symptoms.
  • Cough that does not go away.
  • A sore throat or a slight fever.
  • Soreness in the lymph (limf) nodes of the armpit or neck.
  • Brain, nerve, and mood symptoms.
  • Feeling dizzy or lightheaded when you go from a lying or sitting position to a standing position.
  • Headache that is new or is different from your usual headaches.
  • Mood swings, anxiety, depression (sadness), and irritability.
  • You may be more sensitive to alcohol and medicines. Noise, light, and certain foods or chemicals may bother you more than before. Your skin may also be more sensitive to touch.
  • Problems with memory, thinking, and concentrating (staying focused on a task). Some people with CFS call these symptoms "brain fog." These symptoms may be worse during the first one to two hours after you wake up.

Medical Care:

CFS is an illness that is hard to understand and treat. There is not a special test that can be done to know if you have CFS. It may cause you much stress if caregivers cannot find the reason for your signs and symptoms. You may feel relieved when caregivers tell you that you have CFS. It may take months or years before you slowly improve. But there is no cure for this illness. Your caregiver may suggest one or more of the following tests or treatments:

  • Allergy tests.
  • Blood tests.
  • Exercise.
  • Healthy diet.
  • Medicine for depression.
  • Medicine for joint pain and headache.
  • Medicine to raise your blood pressure if it is too low.
  • MRI (of brain).
  • Psychological (si-ko-lah-ji-kull) testing.
  • Sleep study.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.


  • Chinese ginseng (Panax ginseng) has been used for many years, but has not been studied in people who have chronic fatigue syndrome.
  • Licorice (Glycyrrhiza glabra) has been used for many years, but has not been studied in people who have chronic fatigue syndrome.
  • Siberian ginseng (Eleutherococcus sinensis) has been used for many years, but has not been studied in people who have chronic fatigue syndrome.


  • Carnitine (L-carnitine) may be helpful for chronic fatigue syndrome and has been studied in people.
  • Magnesium has been used, but has not been studied in people who have chronic fatigue syndrome.
  • NADH (nicotinamide adenine dinucleotide) may be helpful for chronic fatigue syndrome and has been studied in people.

Complementary Therapies:

  • Acupuncture may help CFS.
  • Biofeedback may help CFS.
  • Cognitive behavior (b-hav-yer) therapy.
  • Exercise.
  • Light therapy may help CFS.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss your treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.


1. Artsimovich NG, Chugunov VS, Kornev AV et al: The chronic fatigue syndrome. Zh Nevropatol Psikhiatr Im S S Korsakova 1994; 94(5):47-50.

2. Butler S, Chalder T, Ron M et al: Cognitive behaviour therapy in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 1991; 54(2):153-158.

3. Forsyth LM, Preuss HG, MacDowell AL et al: Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999; 82(2):185-191.

4. Fulcher KY & White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ 1997; 314:1647-1652.

5. James LC & Folen RA: EEG biofeedback as a treatment for chronic fatigue syndrome: a controlled case report. Behav Med 1996; 22(2):77-81.

6. Plioplys A & Plioplys S: Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsychobiology 1997; 35(1):16-23.

7. Terman M, Levine SM, Terman JS et al: Chronic fatigue syndrome and seasonal affective disorder: comorbidity, diagnostic overlap, and implications for treatment. Am J Med 1998; 105(3A):115S-124S).

Last Updated: 7/4/2018
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