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Part of the problem with diagnosing and differentiating ME and CFS is that the symptoms are many and vary from patient to patient.  But after a physician has seen many patients, a pattern begins to emerge.  Some patients describe the same symptom in different ways, so it takes a discerning, observant physician to piece together the symptom puzzle.

Most patients will have several symptoms on this list, but it is rare to have them all.  And most symptoms will vary in degree of severity from patient to patient, with some increasing or diminishing for short or extended periods, and some constant, but with varying degrees of severity from day to day or even hour to hour.  But the hallmark of ME is that the patient's symptoms worsen with even minor physical or mental exertion.

This list is based on the Consensus Document for ME/CFS, but by no means exhaustive, since ME/CFS symptoms are many and varied.  In the sidebar of this page we list other comprehensive and detailed symptoms lists.

Neurological/Cognitive Symptoms
Post-Exertional Malaise and Fatigue
Autonomic Manifestations
Neuroendocrine Manifestations
Immune Dysfunction
Sleep Dysfunction
Pain

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Neurological/Cognitive Symptoms

●Easily confused
●Slow information processing
●Difficulty retrieving words
●Occasional slurred speech
●Occasional dyslexia
●Difficulty with mathematics
●Easily distracted
●Forgetfulness (primarily short-term)
●Attention deficit
●Inability to focus vision and attention
●Inability to cope with fast-paced tasks
●Overall feeling of "spaciness" or "brainfog"
Motor Disturbances:
●Loss of muscular coordination
●Muscle weakness
●Muscle twitching
●Loss of balance and clumsiness
Overload phenomena:
●hypersensitivities to light, sound motion, odors
●Inability to block out background noise and focus on on conversation
●Informational overload with inability to multi-task
●Motor overload, with staggering and weakness
●dizziness
●numbness
●tinnitus (ringing in the ears)
●nausea
●shooting pain
●Overload may cause temporary immobilization

Immune Dysfunction
●A general ill or flu-like feeling, more frequent in the acute onset stage of the illness, less frequent in the chronic stages, most notably post-exertionally
●tender lymph nodes
●recurrent sore throat
●new food sensitivities
●new chemical sensitivities
●hyper-sensitivity to medications and their side-effects
●allergies

Sleep Dysfunction
●frequent awakenings
●nightmares or agitated dreams
●non-restorative sleep
●variations in sleepiness and energy throughout the day
●hypersomnia (excessive sleeping)
●Restless legs syndrome
●periodic limb movement disorder (jerking or twitching during sleep)

Pain
●generalized muscle pain
●new onset headaches
●aching, burning shooting pains anywhere in the body
●fibromyalgia is a common concurrent syndrome with ME/CFS
●arthralgia without joint swelling
●Veteran M.E.  practitioners sometimes noted that pain is most frequent in the upper spine and neck area
●abdominal pain

●Flu-like or hangover feeling following minimal physical or mental exertion, sometimes immediate, sometimes delayed several hours or a day or more and associated with immune activation, with  sore throat, tender lymph glands, general malaise, increased pain and cognitive symptoms
●Feeling worse after exercise, rather than better
●Taking a prolonged time to return to pre-exertional function level
●Lack of endurance

Autonomic Manifestations
Orthostatic Intolerance:
●Neurally mediated hypotension (NMH) i.e. problems with regulation of blood pressure and pulse, especially when standing still; with symptoms of dizziness, lightheadedness, slow response to verbal stimuli; an urgency to lie down
●Postural orthostatic tachycardia syndrome (POTS) i.e. Excessive heart rate during 10 minutes of standing still; blood pressure drop upon standing; lightheadedness, dizziness, nausea, fatigue, irregular breathing, visual changes sweating, headaches.
●Delayed postural hypotension i.e. blood pressure drop after many minutes of standing, rather than upon standing
●tilt table test abnormalities
Other autonomic manifestations:
●Palpitations with or without cardiac arrhythmias
●24-hour Holter monitor results with oscillating T-wave inversions and/or flat T-wave
●breathing dysregulation
●shortness of breath
●intestinal irregularities
●irritable bowel syndrome
●diarrhea
●constipation
●alternating diarrhea and constipation
●abdominal cramps
●bloating
●nausea
●anorexia
●urinary frequency
●painful urination
●excessive urination at night
●pain in lower abdomen

Neuroendocrine Manifestations
●loss of thermostatic stability (fluctuations in body temperature; fluctuations of cold and hot in different parts of the body; intolerance to extremes in air temperature; low body temperature)
●night sweats or other sweating episodes
●weight change, with loss of appetite in some patients or abnormal weight gain in others
●worsening of symptoms under increased stress (physical or emotional)
●loss of adaptation to situations of overload
●anxiety