Table of ContentsView AllTable of ContentsThe Problems With DizzinessFatigueWalking: Abnormal Gait in ME/CFSHeart and Blood-Pressure AbnormalitiesTests to Diagnose ME/CFSTreating Chronic Fatigue and Dizziness
Table of ContentsView All
View All
Table of Contents
The Problems With Dizziness
Fatigue
Walking: Abnormal Gait in ME/CFS
Heart and Blood-Pressure Abnormalities
Tests to Diagnose ME/CFS
Treating Chronic Fatigue and Dizziness
Dizziness and fatigue are common symptoms for people withchronic fatigue syndrome(myalgic encephalomyelitis/chronic fatigue syndromeME/CFS). In some cases, it’s a “head rush” now and then or a few moments of staggering when beginning to walk. In other cases, balance is much worse and fainting is a serious threat.Fatigue, too, contributes to challenges and quality of life changes.
The dizziness can be due tometabolism, immune andnervous systemchanges, impacts on blood flow to the brain, fatigue-related changes in the hormonecortisol, and more. Researchers are still working to understand ME/CFS and why dizziness and fatigue are common.
This article looks at some of the specific problems that arise with ME/CFS, including dizziness and fatigue, and why they may occur.
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Dizziness is one of the main symptoms of ME/CFS. It can occur with lightheadedness and even fainting episodes (syncope). This inability to tolerate being in an upright position is referred to as orthostatic intolerance (OI). A 2022 study of 242 people with ME/CFS found nearly all of them (98.3%) reported at least mild symptoms of OI.
With ME/CFS, dizziness can occur with activities as simple as:
What’s the Difference Between Chronic Fatigue Syndrome and Fibromyalgia?
While cancer and other health conditions can lead to fatigue, the symptoms experienced with ME/CFS are considered the most severe type without another medical explanation. A 2024 review of ME/CFS studies scored physical, mental, and cognitive types of fatigue, with cognitive fatigue scoring highest.
The experience of post-exertional malaise is sometimes called a CFS crash. Avoiding activity, or patterns of high activity beyond your abilities and then exhaustion, are associated with fatigue problems. Pacing your activity may be the best approach.
Core Symptoms of ME/CFSThe diagnosis of ME/CFS requires three mainsymptoms: extreme fatigue that worsens with activity (sometimes called a CFS crash) along withsleep disruptions. One other symptom, such as orthostatic intolerance (dizziness when upright) or “brain fog” cognitive problems, also must occur.There are no tests for ME/CFS and a diagnosis can be difficult.
Core Symptoms of ME/CFS
The diagnosis of ME/CFS requires three mainsymptoms: extreme fatigue that worsens with activity (sometimes called a CFS crash) along withsleep disruptions. One other symptom, such as orthostatic intolerance (dizziness when upright) or “brain fog” cognitive problems, also must occur.There are no tests for ME/CFS and a diagnosis can be difficult.
For years, researchers have been studying the walking pattern, orgait, of people with ME/CFS. They’ve found several abnormalities. However, it’s not clear whether gait issues contribute to balance problems, or if the balance problems of ME/CFS are the cause of the gait changes.
A 2016 study inClinical Biomechanicssuggests that gait issues may be directly tied to the inability to maintain balance when first starting to walk.
Other studies have included a “Stops Walking with Eyes Closed while performing a secondary Cognitive Task” (SWECCT) test to assess gait. The results did not show a significant effect.It’ll take more research to know for sure how they impact each other.
How Neurological Conditions Can Cause Ataxia
Multiple (non-lethal)heart abnormalities are linked to ME/CFS, and some of them may be responsible for dizziness in the condition. Heart monitoring is common when trying to find the underlying cause of symptoms, since heart rate and rhythm may play a role in these episodes.
Tests of the autonomic nervous system, which controls vital functions like blood pressure, heart rate, and breathing rate, often show atypical results in people living with ME/CFS.
The reason for why abnormalities with heart and blood pressure are common in people with ME/CFS is generally believed to be related to dysfunction of the autonomic nervous system, which is calleddysautonomia.
What Is Dysautonomia?The autonomic nervous system controls functions in your body outside of your voluntary choices, like blinking your eyes or moving muscles to speak. These functions include heart rate, blood pressure, sweating, food digestion, and more.When this nervous system doesn’t work properly, it’s referred to as dysautonomia (which is believed to play a key role in ME/CFS).
What Is Dysautonomia?
The autonomic nervous system controls functions in your body outside of your voluntary choices, like blinking your eyes or moving muscles to speak. These functions include heart rate, blood pressure, sweating, food digestion, and more.When this nervous system doesn’t work properly, it’s referred to as dysautonomia (which is believed to play a key role in ME/CFS).
There isn’t a specific test to diagnose ME/CFS.Tilt table testsare sometimes used to evaluate OI and determine what’s causing your symptoms.With a tilt table, you are monitored as the table you lie on is moved into different positions.
Other tests that researchers have found valuable in diagnosing the dizziness, fatigue, and other symptoms of ME/CFS reveal:
The research on ME/CFS continues to evolve with, for example, new insights on similarities with COVID-19 infection and “long COVID” patterns following the pandemic.Recent studies show that more than a third of general practice physicians are still skeptical about ME/CFS being a “real” diagnosis, but the science has shown very real disease patterns.
While the pathways for treating the dizziness and fatigue of ME/CFS are still limited, experts are optimistic that research will lead to new treatments. These experts include the ME/CFS Clinical Coalition in the USA and Europe’s EUROMENE group of institutions in 21 countries.
While exercise therapy was once considered an option, it has become controversial.In one case, only 61% of participants were able to complete a study on the benefits of exercise.However, those who did complete it developed better balance and strength.
EUROMENE guidelines state clearly that there is no causal type of treatment, but improvements in quality of life can be made through:
Medication to treat symptoms is recommended. Medications for ME/CFS can include:
Your healthcare provider can recommend options for treating associated symptoms that can occur with the dizziness and fatigue of ME/CFS. People with ME/CFS also may experience:
You also may want to ask about other risks (like falls) due to your diagnosis. They may recommendassistive deviceslike a walking cane.
A Word About PainSome guidelines, including the Canadian Consensus Criteria, place more emphasis on pain as a core symptom experienced with ME/CFS.The most common types of pain are:Muscle pain and achesJoint pain without swelling or rednessHeadaches, either new or worsening
A Word About Pain
Some guidelines, including the Canadian Consensus Criteria, place more emphasis on pain as a core symptom experienced with ME/CFS.The most common types of pain are:Muscle pain and achesJoint pain without swelling or rednessHeadaches, either new or worsening
Some guidelines, including the Canadian Consensus Criteria, place more emphasis on pain as a core symptom experienced with ME/CFS.The most common types of pain are:
Fibro Fog and ME/CFS Brain Fog
Summary
Fatigue and dizziness (often related to orthostatic intolerance) are among the core symptoms needed to accurately diagnose ME/CFS. Pain also is common, as are cognitive challenges often called “brain fog.”
There is no specific test to diagnose ME/CFS, although tilt table tests can help. The evolving science on ME/CFS also finds metabolic tests, and nervous and immune system tests, to contribute to an accurate diagnosis.
There are few treatments as yet for ME/CFS, but researchers note similarities with “long COVID” patterns and are hopeful that treatments will emerge. Your healthcare provider can help you to find lifestyle changes and assistive devices to help with dizziness and fatigue, refer you to support services, and prescribe medication to treat your symptoms.
What Is Long COVID?
16 Sources
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