ME/CFS Diagnosis
Select Your Symptoms From the Checkboxes Below to See If You Have ME/CFS
Answer the checkbox questions below about your symptoms, and you are immediately informed whether your symptoms satisfy standard ME/CFS diagnostic criteria. The questions refer to your baseline level of illness, not the temporarily worsened illness state that occurs during PEM (unless you are a severe patient whose PEM is triggered constantly).
For these questions, to view further clarifying information, press the information button ⓘ by each answer.
Fatigue
ⓘ Physical fatigue involves feeling physically drained or weak. Physical fatigue is characterized by difficulties in performing physical activities, due to lack of muscular strength or lack of physical energy. Only select this fatigue symptom if you are experiencing physical fatigue which is: of a new onset (not life-long), not caused by excessive ongoing physical exertion, and not substantially alleviated by rest.ⓘ Mental fatigue or mental exhaustion involves feeling mentally weary, frayed or drowsy. Mental fatigue is characterized by difficulties concentrating and performing cognitive tasks (such as reading, arithmetic, filling in forms, talking to people, etc). Only select this fatigue symptom if you are experiencing mental fatigue which is: of a new onset (not life-long), not caused by excessive ongoing mental exertion, and not substantially alleviated by rest.
Stamina
ⓘ This means a muscular fatigability that rapidly appears during physical exertion, such that the longer the exertion goes on, the weaker your muscles feel. This muscle weakening can occur fast, within a minute of starting a physical exertion.ⓘ This means you experience rapid mental fatigability when performing mental or cognitive tasks (tasks which quickly exhaust you mentally might include reading, arithmetic, filling in forms, talking to people, etc).
Post-Exertional Malaise (PEM)
ⓘ This is where physical exertion or physical exercise triggers a temporary period of worsened symptoms (and during this period, flu-like symptoms or pain may also appear). This temporary period of worsened symptoms is called PEM, and PEM can begin immediately after exertion, or may hit the next day or so after exertion. Once PEM starts, it can take anything from a day to a week or more to slowly clear up. Once PEM clears up, you then return to your baseline level of symptoms.In severe ME/CFS, even the light exertions of daily living (like cooking or taking a shower) can be enough to trigger PEM. Whereas for moderate ME/CFS, it may require greater exertion levels to cause PEM (such as a brisk 40 minute walk, or going out shopping). For mild ME/CFS patients, their PEM threshold may be higher still, and so much of the time they may not exert themselves sufficiently to trigger PEM.
ⓘ This is where cognitive or emotional exertion, or sometimes just sensory overload (light and sound), triggers a temporary period of worsened symptoms (and during this period, flu-like symptoms or pain may also appear). This temporary period of worsened symptoms is called PEM, and PEM can begin immediately after exertion, or may hit the next day or so after exertion. Once PEM starts, it can take anything from a day to a week or more to slowly clear up. Once PEM clears up, you then return to your baseline level of symptoms.
Cognitive
ⓘ Brain fog can include one or more of the following: poor short-term memory (you may easily forget what you just read or heard), impaired mental focus and concentration, confusion, disorientation, easily overloaded with information, slowed thought, decision making is more difficult, difficulties in recalling words or names (anomia), miscategorization of stimuli (like answering the phone when the doorbell rings), poor working memory and multitasking difficulties (inability to pay attention to more than one thing, forgetting your original task when distracted), difficulty performing simple mathematics.Sleep
ⓘ This means sleep that is not restorative, leaving individuals feeling exhausted and unrefreshed even after a full night's sleep.ⓘ This can include: insomnia, frequent awakenings during the night, sleeping much longer than in your pre-illness state, awaking much earlier than you did in your pre-illness state, vivid dreams or nightmares, circadian rhythm disturbances (such as going to bed many hours later than normal, sleeping in the day and being awake at night, or experiencing non-24, which is where on each successive day, you go to bed later and later, eventually becoming completely out of sync with the day and night).
Lifestyle Impact
ⓘ Select this option if your various symptoms (which may include fatigue, low stamina, PEM, brain fog, etc) substantially reduce your ability to take part in activities that you previously engaged in before your illness started (occupational, educational, social or personal life activities).In the case of mild ME/CFS, patients may be able to work full or part time, but when they come home are too exhausted to contemplate evening activities they may have previously enjoyed, such as socialising, going out for evening entertainment, or playing sports or other physical activities. This is a substantial reduction in activity level. For moderate ME/CFS patients, who are unable to work and do not leave the house much, they experience an even greater reduction in activities. And for severe ME/CFS patients who are bedbound for much of the day and night, there is a huge reduction in activities.
Pain and Headaches
ⓘ Tension headaches, migraine headaches; headaches involving aching of the eyes, aching behind the eyes, or an aching back of the head, all of which may also involve neck muscle tension.ⓘ Pain in the muscles or in the muscle-tendon junctions. The pain is non-inflammatory in nature, occurs in unexpected places and at unexpected times, and often migrates from place to place.
ⓘ Pain in the joints, but without swelling or redness. The pain is non-inflammatory in nature, occurs in unexpected places and at unexpected times, and often migrates from place to place.
Immune Symptoms
ⓘ These are lymph nodes which are swollen. In ME/CFS, it is especially the lymph nodes at the sides of neck and in the armpit area which may be swollen.
ⓘ Tender lymph nodes are ones which are painful when you press on them. In ME/CFS, it is especially the lymph nodes at the sides of neck and in the armpit area which may be tender.
ⓘ Flu-like symptoms are a cluster of symptoms which may include: a sore throat, sinusitis, aching muscles or body, headache, fever, enlarged or tender lymph nodes. In ME/CFS patients these symptoms may worsen after exertion.
ⓘ Malaise is a feeling of overall discomfort, lack of wellbeing and illness, as you might feel if you were beginning to come down with a cold or flu.
ⓘ This is where symptoms are triggered after exposure to certain chemicals. Common chemicals that may trigger chemical sensitivity symptoms include: perfumes, petrochemicals, and smoke from fires. Such chemicals would not trigger symptoms in healthy people, but can affect those with chemical sensitivity. Select this option if you experienced a newly-appearing chemical sensitivity after your symptoms began.
ⓘ This is where symptoms are triggered after eating certain foods. Select this option if you experienced a newly-appearing food sensitivity when all your symptoms began.
ⓘ This is where symptoms are triggered after ingesting pharmaceutical medications. Select this option if you experienced a newly-appearing medication sensitivity when all your symptoms began.
ⓘ This is where you seem to catch every cold or infection that is going around, and once you catch it, it takes you a long time to recover, many weeks or months.
Neurological Symptoms
ⓘ Hyperacusis is a heightened sensitivity to sound, making everyday noises seem extremely disturbing or feel invasive in your mind.ⓘ Photophobia is an increased ocular sensitivity to light, whereby light of a certain brightness can cause eye pain, or desire to avert your vision from the light.
ⓘ Hyperosmia is a hypersensitive sense of smell which can lead to certain smells causing strong discomfort or even triggering illness symptoms.
ⓘ A heightened sensory sensitivity to taste.
ⓘ Hyperesthesia is an increased sensitivity of the skin to touch, also known as tactile sensitivity. Hyperesthesia encompasses both allodynia (feeling pain from a skin stimulus that is not normally painful) and hyperalgesia (feeling abnormally heightened sensitivity to pain).
ⓘ The nervous system is hypersensitive to the effects of vibration.
ⓘ Having trouble focusing your eyes on objects or scenes you are looking at.
ⓘ Depth perception is the ability to see the world in three dimensions, and to judge how far objects are away from you.
ⓘ A sense of weariness or weakness that you feel when using your muscles.
ⓘ Fasciculations are spontaneous involuntary muscle contractions or twitches that occur at random moments. The twitches are too weak to actually move a limb to any degree, but they can be easily felt.
ⓘ This can involve clumsy movements, poor coordination, or being unsteady on feet.
Neuroendocrine Symptoms
ⓘ A temperature below the normal range for the human body. The average body temperature is 37°C (98.6°F). The normal range of body temperature is from 36.1°C (97°F) up to 37.2°C (99°F).ⓘ This feverish feeling can occur with or without an increase in body temperature (that is, with or without fever).
ⓘ More sensitive to hot temperatures (eg: hot baths or hot weather) and/or cold temperatures (cold weather).
ⓘ A major change in body weight compared to the weight you had before your illness started.
ⓘ Symptoms exacerbated by emotional stress arising from adverse life events, problems with people, financial difficulties, etc.
Autonomic Symptoms
ⓘ Many ME/CFS patients have autonomic nervous system dysfunction such that remaining in an upright position (standing up, or even just sitting upright in a chair) may trigger a number of autonomic symptoms such as dizziness, feeling faint, light-headedness, nausea or fatigue. These autonomic symptoms may be due to a specific diagnosed autonomic condition such as POTS, NMH or OH, or may be due to some non-specific autonomic dysfunction. This inability to tolerate or maintain an upright position is called orthostatic intolerance.ⓘ POTS is a comorbid illness often found in ME/CFS. With POTS, adopting an upright posture (standing up) will trigger or worsen certain symptoms (such as tachycardia, headache, abdominal discomfort, dizziness, feeling faint, nausea, fatigue, light-headedness, sweating). POTS can be diagnosed by a specialist, but is also easily diagnosed at home, by measuring the change in your heart rate on standing up, using the active standing test protocol detailed here. Anyone considering if they might have ME/CFS would be advised to test for POTS.
ⓘ NMH is an illness sometimes found in ME/CFS. With NMH, adopting an upright posture (standing up) will trigger or worsen certain symptoms (such as dizziness or light-headedness, feeling that you are going to faint, blurred vision, confusion, weakness, fatigue, nausea). NMH is diagnosed using a tilt table test that keeps the patient in the upright position for 30 to 45 minutes, to observe whether syncope occurs (syncope is a loss of consciousness due to a drop in blood pressure). More details here.
ⓘ OH is an illness sometimes found in ME/CFS. With OH, adopting an upright posture (standing up) will trigger or worsen certain symptoms (such as dizziness or light-headedness, feeling that you are going to faint, blurred vision, confusion, weakness, fatigue, nausea). OH is diagnosed by measuring any drop in your blood pressure on standing up, more details here.
ⓘ Light-headedness is feeling as if you might faint.
ⓘ Dizziness is feeling faint, giddy, weak, unsteady, or off-balance. Dizziness may involve a sensation of motion, or a feeling that everything is spinning around.
ⓘ Heart palpitations are feelings of having a fast-beating, pounding or fluttering heart.
ⓘ Air hunger (dyspnea) during physical activity is the sensation of running out of air, and not being able to breathe fast or deeply enough to replenish oxygen.
ⓘ Labored breathing is where it requires an increased effort to breathe.
ⓘ Pallor is when your skin (especially face) looks pale and lacking in color. It may be caused by reduced blood flow, or lack of red blood cells.
ⓘ IBS may involve: a change in bowel movements (such as diarrhoea, constipation or both), bloating and swelling of the stomach, excessive wind (flatulence), abdominal pain and cramping.
ⓘ Urinary urgency involves a sudden need to urinate, despite not having a full bladder — a need often so intense that you are unable to delay going to the toilet.
Illness Onset
ⓘ With rapid onset ME/CFS, symptoms quickly appear within days or weeks of an acute infection. With gradual onset ME/CFS, symptoms appear slowly and incrementally over a few months or longer after the acute infection. With relapsing-remitting onset, there are large ups and downs in symptom severity for many months after the acute infection, before eventually settling into stable symptoms.Symptoms Questionnaire Results
| Set of Diagnostic Criteria | Number of Criteria Satisfied | ME/CFS Diagnosed? |
| IOM | ||
| Fukuda | ||
| Canadian consensus criteria | ||
| International consensus criteria | ||
| The second column above shows how many criteria in each set of ME/CFS diagnostic criteria your symptoms have satisfied. When you satisfy all the criteria in the set, you receive an ME/CFS diagnosis, indicated in the third column. | ||
Answering the Questionnaire
The symptoms entered above are checked against four standard ME/CFS diagnostic criteria: the IOM criteria, the CDC Fukuda criteria, the Canadian consensus criteria (CCC) on page 2, and the international consensus criteria (ICC) on page 7.
You are informed whether your symptoms satisfy each of these four sets of criteria to give you an ME/CFS diagnosis.
However these standard criteria can only diagnose ME/CFS if you have no other medical conditions which might be responsible for your symptoms. Conditions such as hypothyroidism, celiac disease, lupus, anemia and several other illnesses can cause symptoms similar to those of ME/CFS, so must be ruled out before you can entertain an ME/CFS diagnosis.
ME/CFS is diagnosed on symptoms alone, using standard ME/CFS diagnostic criteria, because there are presently no medical blood tests or scans that can determine if you have ME/CFS.
Note that this questionnaire is provided for information purposes only, and its results should not be considered medical advice. Please consult your doctor regarding any ME/CFS diagnosis. Seeing your doctor is especially important in terms of getting blood tests to rule out other much more treatable conditions which might masquerade as ME/CFS.
Privacy statement: the answers you enter are not recorded or collected, and you are not asked for any personal information, nor asked for your email.
ME/CFS Diagnostic Criteria Compared
These four diagnostic criteria each have their own characteristics: the CCC and ICC are more precise and exacting, and thus if you satisfy these criteria, you can generally be more confident that you may have ME/CFS (provided you have already ruled out medical conditions that can cause symptoms similar to those of ME/CFS). However, because these criteria are exacting, they can sometimes exclude patients who may otherwise get diagnosed with ME/CFS by less exacting criteria.
The IOM and especially the Fukuda criteria are less exacting, and are also a shorter set of criteria, so are easier to use.
It is often argued that post-exertional malaise (PEM) is a cardinal feature of ME/CFS. PEM is where a bout of physical or cognitive exertion will cause your symptoms to temporarily become worse in the subsequent days. All four sets of criteria except Fukuda require PEM as a mandatory symptom for ME/CFS diagnosis. So if you have many ME/CFS symptoms, but do not experience PEM, you can still receive an ME/CFS diagnosis by Fukuda.
The ICC is the only set of criteria that does not require fatigue as a mandatory symptom for diagnosis of ME/CFS. The CCC requires fatigue, fatigability (lack of stamina) and PEM to all be present for an ME/CFS diagnosis; whereas the ICC only requires fatigability and PEM, but does not require not fatigue. The ICC is similar to the CCC, but is an evolution of the CCC.
Some patients have many ME/CFS symptoms including fatigability and PEM, but do not normally experience ongoing fatigue, except as a result of a lack of stamina during exertion, or perhaps during a PEM episode. For such patients, the ICC is the only set of criteria which can diagnose them with ME/CFS.
The ICC also does not require adults to have had their symptoms for at least 6 months before an ME/CFS diagnosis is given. Whereas the other three ME/CFS criteria specify this 6 month minimum period.
One reason why some sets of criteria withhold a diagnosis until 6 months is because there is a condition called post-viral fatigue that can appear after a viral infection, and which has the same symptoms as ME/CFS, but typically clears up within 6 months (although sometimes post-viral fatigue may even take a year or two to clear up).
Note that the IOM and Fukuda sets of criteria do not make a distinction between physical versus mental when it comes to the symptoms of fatigue and PEM, so in these cases, this questionnaire will accept either as satisfying the fatigue and PEM criteria. The CCC requires both physical fatigue and mental fatigue to satisfy the fatigue criterion, as well as both low physical stamina and low mental stamina to satisfy the poor stamina criterion; but the CCC does not make a distinction between physical exertion PEM and mental exertion PEM, so in this questionnaire, having either is acceptable for satisfying the PEM criterion. The ICC will accept either physical exertion PEM or mental exertion PEM as satisfying the PEM criterion, and will accept either low physical stamina or low mental stamina as satisfying the low stamina criterion, so that is reflected in this questionnaire.