Chronic Fatigue Syndrome : 6 Symptoms You are Probably Overlooking

For millions of people globally, extreme exhaustion isn’t merely a consequence of a poor night’s sleep it’s a debilitating and often misunderstood condition known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by persistent fatigue, but it also affects multiple body systems. Many of its early warning signs are easily dismissed or confused with stress, burnout, or depression.

ME/CFS, a serious and complex illness, goes beyond mere fatigue. It profoundly affects the brain, immune system, and energy production at the cellular level, as explained by Dr. Lucinda Bateman, founder of the Bateman Horne Center, which specializes in treating ME/CFS and other complex chronic diseases.

Here are six commonly overlooked symptoms of ME/CFS that can help you identify it early and seek appropriate care.

1. Post-Exertional Malaise (PEM)

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by a distinct feature called PEM, which refers to a significant worsening of symptoms even after engaging in relatively minor activities, such as walking, working at a desk, or showering.

Patients often describe it as a “crash,” where their body feels like it’s shutting down hours or even days after engaging in physical activity, according to Dr. Bateman.

PEM can persist for days or even weeks, and no amount of sleep appears to alleviate the symptoms.

2. Brain Fog & Cognitive Dysfunction

Many people with ME/CFS struggle with a condition often referred to as “brain fog.”

• Trouble concentrating
• Short-term memory issues
• Word-finding difficulties
• Slowed processing speed

These symptoms resemble those of ADHD or early dementia, but they are linked to the impact of ME/CFS on cognitive energy and brain inflammation.

3. Dizziness or Feeling Lightheaded When Standing (Orthostatic Intolerance)

Do you feel faint or dizzy when you get out of bed or stand still? If so, you might be experiencing orthostatic intolerance, a common but often overlooked symptom of ME/CFS. In some cases, orthostatic intolerance can manifest as Postural Orthostatic Tachycardia Syndrome (POTS).

According to the CDC, over 90% of people with ME/CFS have some form of orthostatic intolerance.

4. Unrefreshing Sleep

Even after sleeping for 8+ hours, people with ME/CFS often wake up feeling just as exhausted as before.

Studies have revealed that disruptions in deep, restorative sleep stages and abnormal overnight brain activity further deplete energy levels during the day.

5. Chronic Pain That Doesn’t Fit a Pattern

This can include:

• Joint pain without swelling
• Muscle soreness
• Headaches or migraines
• Sensitivity to touch or pressure

ME/CFS, although not classified as an inflammatory disease like rheumatoid arthritis, often alters neurological pain processing, resulting in heightened pain perception.

6. Flu-Like Symptoms That Never Fully Go Away

Many people report:

• Sore throat
• Swollen lymph nodes
• Low-grade fever
• Chills

These are indicators that the immune system is perpetually activated, even in the absence of an active infection. In fact, many cases of ME/CFS are triggered by viral infections, such as Epstein-Barr virus and COVID-19.

What Research Tells Us

• People with ME/CFS have abnormal energy production at the cellular level.
• Their immune systems show signs of chronic low-grade inflammation.
• Brain imaging reveals structural changes and reduced blood flow.

Despite growing evidence, diagnosis of ME/CFS remains challenging. This is because there is no single lab test, and many healthcare providers lack the necessary training.

Why It Matters: Public Health & Awareness

More than 2.5 million Americans are believed to be living with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), yet many remain undiagnosed or misdiagnosed for years.

“Early recognition is crucial,” says Dr. Anthony Komaroff, professor at Harvard Medical School and ME/CFS researcher. “It can prevent worsening and guide better care strategies, including pacing and symptom management.”

As the number of Long COVID cases rises, experts caution that we may soon witness a resurgence of post-viral ME/CFS diagnoses.

What You Can Do if You Suspect ME/CFS

If you recognize these symptoms in yourself or a loved one:

• Track your symptoms daily, especially after activity
• Talk to a primary care doctor or neurologist with ME/CFS experience
• Ask about orthostatic testing or referral to a post-viral fatigue clinic
• Learn to “pace” a strategy that avoids overexertion and helps manage energy

Don’t Ignore the Signals

ME/CFS is not a figment of your imagination; it’s a medically recognized and life-altering condition that demands genuine attention, research, and care. If you’ve been experiencing persistent exhaustion, confusion, or frequent crashes, it’s more than just burnout. Trust your body and advocate for your health. Remember, recovery begins with recognition.