NICE Guideline > Symptoms for suspecting ME/CFS

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Symptoms for suspecting ME/CFS

All of these symptoms should be present:

  • 1. Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.

2. Post-exertional malaise after activity in which the worsening of symptoms:

- is often delayed in onset by hours or days,

- is disproportionate to the activity,

  • - has a prolonged recovery time that may last hours, days, weeks or longer.

3. Unrefreshing sleep or sleep disturbance (or both) , which may include:

  • - feeling exhausted, feeling flu-like and stiff on waking,
  • - broken or shallow sleep, altered sleep pattern or hypersomnia.

4. Cognitive difficulties (sometimes described as 'brain fog') , which may include:

  • - problems finding words or numbers,
  • - difficulty in speaking,
  • - slowed responsiveness,
  • - short-term memory problems, and difficulty concentrating or multitasking.

1.2.4 Be aware that the following symptoms may also be associated with, but are not exclusive to, ME/CFS:

  • - orthostatic intolerance and autonomic dysfunction, including dizziness, palpitations, fainting, nausea on standing or sitting upright from a reclining position.
  • - temperature hypersensitivity resulting in profuse sweating, chills, hot flushes, or feeling very cold.
  • - neuromuscular symptoms, including twitching and myoclonic jerks.
  • - flu-like symptoms, including sore throat, tender glands, nausea, chills or muscle aches.
  • - intolerance to alcohol, or to certain foods and chemicals.
  • - heightened sensory sensitivities, including to light, sound, touch, taste and smell.
  • - pain, including pain on touch, myalgia, headaches, eye pain, abdominal pain or joint pain without acute redness, swelling or effusion.

1.2.5 Primary healthcare professionals should consider seeking advice from an appropriate specialist if there is uncertainty about interpreting signs and symptoms and whether an early referral is needed. For children and young people, consider seeking advice from a paediatrician.

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