This page introduces the diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), offering evidence-based guidance and links to the most accessed professional resources.
Diagnosing & Managing
ME/CFS Diagnostic Criteria
National Academy of Medicine 2015 Diagnostic and Treatment Guidelines
A diagnosis of ME/CFS requires the patient to have three core symptoms:
- Impairment of normal function accompanied by fatigue >6 months
- Post-exertional malaise (PEM)*
- Unrefreshing sleep*
Plus at least one of the following manifestations:
- Cognitive impairment*
- Orthostatic intolerance (OI)
*Must be moderate-to-severe and present >50% of the time
- Cognitive Impairment*
- Orthostatic Intolerance (OI)
*Must be moderate-to-severe and present >50% of the time
Additional Symptoms Supporting Diagnosis
Neurological impairment: Impaired psychomotor function, muscle weakness, twitching, instability, spatial disorientation, ataxia, sensory changes (e.g. sensitivity or intolerance to light, noise and touch).
Other: Gastrointestinal impairments, genitourinary impairment, neuroendocrine manifestations (e.g. cold extremities, weight change, excessive sweating, high/low temperature, chills/shivers, loss of appetite, alcohol intolerance).
Pain: Headaches, arthralgia, myalgia, other pain symptoms (all highly variable in presence, nature and severity).
Other comoribid conditions may exisit in those with ME/CFS. For more about diagnosis and managment of these common comorbidities see our video series on Unraveling the Complexities of Pain & Fatigue as well as the Long COVID & Post-Viral Syndromes ECHO.
Diagnosing and Managing ME/CFS
U.S. ME/CFS Clinician Coalition
- Testing Recommendations for Suspected ME/CFS (2021)
- ME/CFS Treatment Recommendations (2021)
- Basics of Diagnosis & Treatment (2020)
- Expert Consensus Statements of the U.S. ME/CFS Clinician Coalition (video, 2022)
Mayo Clinic Proceedings
Center for Disease Control (CDC)
Doctors with M.E.
Michigan State Medical Society (1.5 CME credits)
- Long COVID & Post-Viral Syndromes (May 2022)
Long COVID & Fatiguing Illness Recovery Program
- History of ME/CFS (May 2022)
- Register for series
For CME specific to diagnosing and managing ME/CFS and related comorbid conditions, please refer here.
Top Medical Professional Resources
Care Considerations
- ER & Urgent Care Considerations for ME/CFS (PDF)
- Low-Dose Naltrexone (LDN) Management Overview
- Low-Dose Naltrexone (LDN): A Note to Providers (PDF)
- Caring for People with Severe ME/CFS (PDF)
Orthostatic Intolerance
- Orthostatic Intolerance Overview
- 10-Minute NASA Lean Test (passive stand test)
- Orthostatic Intolerance (basics)
- Assessing Orthostatic Intolerance (6 min video)
- Managing Orthostatic Intolerance (5 min video)
Post-Exertional Malaise (PEM)
- PEM/PESE 7-part video series (NEW!)
- Understanding PEM (videos, Doctors with M.E.)
- ME/CFS Crash Survival Guidebook
Pre-visit Forms for Patients
- Good Day/Bad Day Questionnaire (HUA & function)
- Health Assessment Form
Medical Education: Project ECHO
- Long COVID & Post-Viral Syndromes (video, slides)
- Post-Exertional Malaise/PEM (video, slides)
- Part 1: Orthostatic Intolerance Assessment (video, slides)
- Part 2: Managing Orthostatic Intolerance (video, slides)
- Sleep Disturbances/Dysregulation (video, slides)
- Mast Cell Activation Syndrome/MCAS (video, slides)
- Cognitive Impairment (video, slides)
- Anxiety & PTSD (video, slides)
- Chronic Pain (video, slides)
- Post-Viral Gastrointestinal Disruption & Dysfunction (video, slides)
- Pediatric Long COVID (video, slides)
- COVID-19 and Gynecological Health (video, slides)
- What Pathological Changes May Cause the Symptoms of Long COVID (video, slides)
- Headaches in Post-Acute Sequelae of COVID-19 (video, slides)
Note: Live ECHO sessions are reserved for healthcare professionals only. Sessions include: didactic, case presentations and CME.
Lucinda Bateman, MD, is a renowned clinician, researcher, and educator. Her Johns Hopkins University Medical School training instilled an approach to care that she has employed throughout her career - the patient comes first and the unknown or unexplained does not equate to a lack of proper and compassionate care. Since starting her own practice in 2000, she has served on six boards or committees, been the principal investigator for 45 studies, authored/coauthored 40 journal articles, served as adjunct instructor and adjunct assistant professor in the University of Utah Departments of Preventative Medicine, Internal Medicine, and Anesthesiology, and lectured around the world.