E3 PreliminaryPreliminaryPEM unclearReview-NarrativePeer-reviewedMachine draft
The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology.
Hulens, Mieke, Rasschaert, Ricky, Vansant, Greet et al. · Journal of pain research · 2018 · DOI
Quick Summary
This review paper proposes that ME/CFS, fibromyalgia, and a condition called idiopathic intracranial hypertension (IICH—where pressure builds up around the brain) may share similar underlying causes. All three conditions cause widespread pain, fatigue, cognitive problems, and other symptoms that could potentially be explained by increased pressure in the fluid surrounding the brain and spinal cord.
Why It Matters
This hypothesis could redirect research toward measuring intracranial and spinal fluid pressure in ME/CFS patients, potentially identifying a treatable underlying mechanism. If supported by future clinical studies, it might explain why ME/CFS patients experience such varied and severe symptoms and could open new diagnostic and therapeutic avenues.
Observed Findings
- IICH, fibromyalgia, and ME/CFS share overlapping symptoms: headaches, fatigue, cognitive impairment, gray matter loss, and cranial nerve involvement.
- All three conditions show strong female predominance and frequent association with Ehlers-Danlos syndrome.
- Increased pressure in spinal canals and nerve root sheaths can cause widespread pain, weakness, ataxia, and bladder/bowel dysfunction—symptoms present in all three conditions.
- All three conditions are frequently associated with sympathetic nervous system overactivity and obesity.
Inferred Conclusions
- The authors propose that elevated cerebrospinal fluid pressure may be a unifying pathophysiological mechanism underlying the overlapping symptoms of IICH, fibromyalgia, and ME/CFS.
- They suggest that direct measurement of intracranial and spinal fluid pressure should be investigated in fibromyalgia and ME/CFS patients.
- The strong association of all three conditions with Ehlers-Danlos syndrome may indicate a connective tissue basis for altered fluid pressure dynamics.
Remaining Questions
- Do ME/CFS and fibromyalgia patients actually have elevated intracranial or cerebrospinal fluid pressure when measured directly?
- What causes the elevated cerebrospinal pressure in these conditions, and is it the same mechanism across all three?
What This Study Does Not Prove
This review does not prove that elevated intracranial pressure causes ME/CFS or fibromyalgia—it presents a hypothesis based on symptom overlap. Shared symptoms do not establish shared cause; the paper is observational and comparative, not a causal study. Direct measurement of intracranial pressure in ME/CFS patients would be needed to test this hypothesis.
Tags
Symptom:Cognitive DysfunctionPainFatigueSensory Sensitivity
Biomarker:Neuroimaging
Method Flag:Exploratory Only
Metadata
- DOI
- 10.2147/JPR.S186878
- PMID
- 30573989
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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