Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) in Adolescents: Practical Guidance and Management Challenges

Figures & data

Table 1 Management of Common Symptoms in ME/CFS

Complaint	Symptom	Non Pharmacological	Pharmacological	Comments
Sleep disturbance				Improvement in sleep disturbance may help pain, “brain fog”, orthostatic intolerance and fatigue.
	Sleep initiation	Sleep hygiene- Regular sleep times, turn off technology etc	Melatonin -regular time – half to one hour prior to sleep time
	Frequent waking	Management of orthostatic intolerance if present	Low dose tricyclics
	Phase-shift	Gradual change of waking and sleeping times with sleep hygiene techniques, blue light etc	Melatonin in conjunction. May use short* course eg temazepam
	Vivid nightmares parasomnias	Reassurance that common with disturbed sleep. Improvement in sleep quality and duration reduces frequency of these events
Orthostatic intolerance				Dizziness, anxiety, headache, “brain fog”, nausea, extreme fatigue or fainting
	Orthostatic tachycardia	Increased salt/ fluids Compression stockings Increasing lower limb muscle tone with gentle exercise	Medications to reduce heart rate fluctuations	If simple measures insufficient – referral to a cardiologist with interest in electrophysiology. Tilt table testing may be required
	Neurally mediated hypotension	Increased salt/ fluids Compression stockings Increasing lower limb muscle tone with gentle exercise	Medications to support blood pressure
Headache	Chronic daily headache	Improvement in sleep hygiene and orthostatic intolerance sometimes helps	Trial of migraine prophylactics anecdotally helpful eg pizotifen, cyproheptadine	Usually unresponsive to normal pain medications, eg paracetamol
Dysmenorrhea			Usually requires suppression ovulation rather than just pain relief	Exacerbation of ME/CFS symptoms common during menstruation
Fibromyalgia	Generalized pain with trigger points	Attention to improving sleep disturbance, increasing gentle exercise	Initially tricyclics,

Notes: *As high risk of dependency use for only 5–7 days at a time. More extensive information regarding symptom management is available in Rowe et al.⁹⁶

Rowe PC, Underhill RA, Friedman KJ, et al. Myalgic encephalomyelitis/chronic fatigue syndrome diagnosis and management in young people: a primer. Front Pediatr. 2017;5:121. PMID: 28674681; PMCID: PMC5474682. doi:10.3389/fped.2017.00121

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