MEDICAL MATTERS
- Medical Matters features questions asked by Members of the ME Association on health-related topics.
- Dr Charles Shepherd and the ME Association's other advisers answer these questions by sharing their expert knowledge.
- Medical Matters is based on the popular ‘Ask the Doctor’ series in ME Essential magazine.
- It is a free resource that supplements the detailed information contained in the full range of literature that can be found in the website shop.

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Questions in the Category: Caffeine
Caffeine-containing drinks – are they safe if you have ME?
I know I probably drink far too much coffee – about 5 cups a day – but it helps me to ‘wake up' in the morning and stay more alert during the day. But what do we know about the effect of caffeine on the brain? Is it actually harmful or beneficial to people with ME/CFS?
Shakiness
I am hoping you can shed some light on two types of shakiness which I've had since a recent relapse of my ME.
Some days I start feeling shaky shortly after getting moving in the morning. It's like I've had a big dose of caffeine (which I definitely haven't) and at its worst my hands will be too shaky to do anything fiddly like sewing but resting is hard because I feel wired with it. It normally fades around the middle of the day. It's intermittent and there are no obvious triggers.
More difficult to describe is a sensation I get sometimes which is more disturbing. It's like an inner wobble, possibly centred around my abdomen. It comes and goes and tends to make me feel vaguely weak. It's possible that one trigger is doing too much but otherwise it's random and can disappear for weeks. I find it difficult because I don't know whether I should be resting more when I have this shakiness or trying to ignore it like a lot of other symptoms.
Muscle twitching/fasciculations
Unlike some people with ME, I don’t have a big problem with muscle pain. But I do get muscle twitching, especially when I’m tired or going through a ‘bad patch’. The twitching not only affects the big muscles in my arms and legs – it sometimes affects muscles on the face and makes my eyelids twitch as well! Is this a recognized problem in ME? And is there anything I can do to relieve it?
Eyelid twitching – Blepharospasm
During the course of my illness I’ve experienced muscle twitching in my legs and sometimes in my arms. The twitching tends to occur when I’m not feeling well or tired. And while this can be annoying it doesn’t normally interfere with what I want to do. I’ve recently started having a similar problem with my eyelids. Is this common in ME/CFS? And is there any form of treatment?
Management: Heart Health & ME/CFS
Can I ask what the advice is on heart health for people with ME? As most of us can’t exercise, how do we maintain a healthy cardiovascular system? Is a healthy diet enough?
Symptom: Tremor
I understand that a tremor, or shaking in the hands, sometimes occurs in ME/CFS. But it could also be a sign of Parkinson’s disease. I’m in my mid fifties and have had moderate ME/CFS for about five years. It is fairly stable but the tremor, which is in both hands and tends to be more noticeable when I’m fatigued, has only been present for a few weeks. Should I see my GP?
Dr Charles Shepherd
Dr Shepherd has been Trustee and Hon. Medical Adviser to the ME Association for more than 40 years. He is integral to the charity's activities and provides information and support based on his professional knowledge, personal experience as a doctor with ME/CFS, and the understanding gained from helping many thousands of people with the condition. He was a member of the comittee responsible for the 2021 NICE Clinical Guideline and is a recognised expert on ME/CFS in the UK. His knowledge extends to Post-Viral Fatigue Syndromes (PVFS), Myalgic Encephalopathy/Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or Long Covid.

If you have questions about ME/CFS or Long Covid, you can:
- Review the free information in the What is ME/CFS section of the website, and the free Covid-19 and Long Covid information in the website shop.
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Medical Matters is based on the popular ‘Ask the Doctor‘ series featured in the highly-regarded member’s magazine, ME Essential, and in the healthcare professional magazine, ME Medical. Both are produced by the ME Association and published as hard-copy magazines every 3 months and sent to members and healthcare professionals by post to home or business addresses.

If you are a Health Care Professional you can sign-up to receive ME Medical magazine (people with ME/CFS can also nominate their HCP by completing the sign-up form).
