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Medically reviewed by Dr. C.H. Weaver M.D. updated 2/2020

It’s normal to feel very tired, or fatigued, from time to time, but severe tiredness that does not go away with rest, is worsened with physical or mental activity, and is not caused by other illnesses is not normal. This type of fatigued is called chronic fatigue syndrome (CFS). The condition is mostly commonly seen in women between age 30 and 50, and, according to the Centers for Disease Control and Prevention, more than 1 million Americans have CFS. Possible complications of CFS include depression, a substantially lower level of activity, side effects of treatment, and social isolation due to fatigue.

When you’re first diagnosed with CFS, it’s difficult to predict the outcome of the condition. Some patients may fully recover between six months and a year, whereas it may take longer for others. Certain patients, however, never fully recover. Treatment and extensive rehabilitation can increase your chances of a complete recovery.


There is no known specific cause of CFS. Some experts think that it may be caused by viruses like Epstein-Barr virus or human herpes virus-6 (HHV-6). Another theory is that CFS may be the result of an immune response or process that causes inflammation in the nervous system. In addition, age, previous illness, stress, environment, and genetics may contribute to the development of CFS.


Symptoms of CFS include muscle aches, headache, and fatigue. You may feel like you have a common viral infection such as the flu, but with CFS symptoms last for six months or more and can persist for years. The level of fatigue associated with CFS is more severe than you have ever experienced before, lasts for six months or more, and does not go away with rest. This type of fatigue makes it difficult or impossible to carry out normal activities.

Other symptoms of CFS include:

  • Fatigue that lasts more than 24 hours after an amount of exercise that is normally easily tolerated
  • Fatigue than is not relieved by adequate sleep or rest
  • Forgetfulness, difficulty concentrating, confusion, and irritability
  • Headaches with different symptoms, patterns, and severity than previously experienced
  • Muscle and joint pain without swelling or redness
  • Tenderness in the lymph nodes in neck or armpit
  • Mild fever (101 degrees)
  • Sore throat

Diagnosing Chronic Fatigue Syndrome

The first step in diagnosis of CFS may be to rule out other possible causes of fatigue. These may include other health conditions—such as infections, endocrine diseases, muscle or nerve diseases (multiple sclerosis, for example), tumors, immune or autoimmune disorders, and conditions including heart, liver, or kidney. Though there are no specific tests to diagnose CFS, tests may be performed to rule out these other conditions. Additional potential causes other than CFS of severe fatigue include drug dependence and psychiatric diseases such as depression. To be diagnosed with CFS, you must also have at least four of the symptoms listed above under “Symptoms” and suffer from severe, long-term fatigue.

How Is It Treated?

Chronic fatigue syndrome cannot be cured at this time, but specific symptoms can be treated to help improve general health and well-being. Early treatment can improve outcomes. A combination of approaches may be used—these include a healthy diet, medication, and sleep management techniques. Medications for CFS may include drugs to reduce pain, discomfort, and fever; drugs to treat anxiety, and drugs to treat depression. As well, because CFS may be associated with depression, antidepressant drugs may be used. Some patients also benefit from cognitive-behavioral therapy (therapy to identify and change negative thinking and behavior) and graded exercise (activity that starts slowly and gradually increases over time).

Living with Chronic Fatigue Syndrome

Chronic fatigue syndrome varies in severity, so while some patients can maintain fairly active lives, others will have to make significant changes at home and at work or school. If you’re living with CFS, you may need to adjust your activities to accommodate your energy level. Your doctor can help you determine your appropriate activity level, as well as make adjustments as needed and gradually increase activity as you’re able. Successfully managing your activity may include the following:

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  • Avoiding doing too much when you feel tired
  • Finding the right balance between activity, rest, and sleep
  • Breaking big tasks into smaller, more manageable ones
  • Spreading out challenging tasks throughout the week

In addition to primary treatment, you may also find that relaxation techniques help you manage chronic pain and fatigue. These techniques include biofeedback, deep breathing exercises, hypnosis, massage therapy, meditation, muscle relaxation techniques, and yoga.

If you have CFS, some of challenges you’ll face include these listed below. Support groups, counseling, and your healthcare team can help you learn strategies to cope with these changes:

  • Changing and unpredictable symptoms
  • A decrease in stamina that makes it difficult to carry out daily activities
  • Memory or concentration problems that can affect work and school
  • Loss of independence and, potentially, economic security if you can’t continue to work
  • Changes in relationships with family, friends, and intimate relationships


CFIDS Association of America

Chronic Fatigue Syndrome Advisory Committee


  1. Chronic Fatigue Syndrome. Medline Plus website. Available at: Accessed January 2020.
  2. Chronic Fatigue Syndrome. Center for Disease Control and Prevention website. Available at: Accessed January 2020.