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
Symptoms Supporting Diagnosis
Diagnosing and Managing ME/CFS
Top Resources

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

 

Plus at least one of the following manifestations: 

  • Cognitive Impairment*
  • Orthostatic Intolerance (OI)

*Must be moderate-to-severe and present >50% of the time

 

Additional Symptoms Supporting Diagnosis

Immune impairment: Acute infection-like onset, susceptibility to infection, perpetual flu-like symptoms, sore throat, tender lymph nodes, fever, new or worsened sensitivities to certain substances (e.g. foods, odors, medications, chemicals). Poor NK cell cytotoxicity (NK cell function, not number) correlates with illness severity in patients and could serve as a biomarker for the severity of the disease.

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 

Mayo Clinic Proceedings

Center for Disease Control (CDC)

Doctors with M.E.

Michigan State Medical Society (1.5 CME credits)

Long COVID & Fatiguing Illness Recovery Program

For CME specific to diagnosing and managing ME/CFS and related comorbid conditions, please refer here. 

 

Top Medical Professional Resources

Care Considerations 

Orthostatic Intolerance 

    Post-Exertional Malaise (PEM)

    Pre-visit Forms for Patients 

    Medical Education: Project ECHO 

    Note:  Live ECHO sessions are reserved for healthcare professionals only. Sessions include: didactic, case presentations and CME.  

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