Dizziness and chronic fatigue are two common but often overlooked symptoms of modern life. However, in people with chronic fatigue syndrome, also known as myalgic Encephalomyelitis (ME/CFS), these two symptoms are central to serious functional and quality-of-life impairment. They are more than just a feeling of tiredness after a day’s work or a brief moment of lightheadedness.
In other cases, balance is much poorer and fainting is a serious threat. Fatigue also contributes to difficulties and changes in quality of life.
Dizziness can be caused by metabolic, immune and neurological changes, effects on blood flow to the brain, fatigue-related changes in the hormone cortisol, and more.
Dizziness problems
In people with ME/CFS, dizziness can occur in very ordinary situations, such as standing up to get something, going to the bathroom, driving, or simply standing in the kitchen cutting vegetables. Feeling lightheaded, disoriented, staggering for a few seconds when starting to walk, or even fainting, can all occur. This is a specific disorder called orthostatic intolerance (OI), which may stem from a disorder of the autonomic nervous system, which controls basic life functions such as blood pressure, heart rate, and breathing.
A study of 242 people with ME/CFS found that nearly all (up to 98.3%) had experienced at least one episode of OI. This suggests that dizziness is not a random occurrence, but rather a core part of the pathology of this syndrome.
Fatigue problems
Unlike normal fatigue, fatigue in ME/CFS does not improve with rest and often gets worse after exertion, even mild exercise. This is a phenomenon called post-exertional malaise (PEM). People with ME/CFS may feel exhausted after ordinary activities such as bathing, having a long conversation or taking a short walk.
Fatigue is often accompanied by a feeling of heaviness in the head, blurred vision, difficulty concentrating and body aches. They are prone to “energy crashes” in the middle of the day that do not recover even after a long sleep.
Cardiac and Blood Pressure Abnormalities
A number of non-fatal cardiac abnormalities have been associated with ME/CFS, and some of them may have been responsible for this patient’s dizziness. Cardiac monitoring is often necessary when trying to find the underlying cause of symptoms, as heart rate and rhythm may play a role in these episodes.
Tests of the autonomic nervous system, which control vital functions such as blood pressure, heart rate, and breathing, often produce atypical results in people with ME/CFS.
The reason why cardiac and blood pressure abnormalities are common in people with ME/CFS is often thought to be related to dysfunction of the autonomic nervous system, known as autonomic dysfunction.
Treatment of ME/CFS and dizziness
Currently, there is no cure for chronic fatigue syndrome and its accompanying symptoms such as dizziness.
Treatments and support include:
- Pace making: People are encouraged to break up their work into smaller tasks throughout the day, take regular breaks, and avoid “exertion-burnout” patterns.
- Sleep management: Establishing regular sleep habits, avoiding stimulants, and using relaxation techniques can improve sleep quality to some extent.
- Heart rate monitoring: Some people use wearable devices to monitor their heart rate, which can help them adjust their activity levels accordingly.
- Cognitive behavioral therapy (CBT): Although its effectiveness is controversial, some people find CBT helpful in managing emotions, anxiety, and adjusting to life with a chronic illness.
