Fibro Fog and ME/CFS Brain Fog

People with fibromyalgia or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) experience a specific kind of cognitive dysfunction called fibro fog or brain fog. It involves:

• Short-term memory problems
• Difficulty concentrating or multi-tasking
• Trouble recalling words and names

Brain fog can have a tremendous impact on quality of life—as much as pain or fatigue. The effects of brain fog can be so significant that it can even be mistaken for ADHD or dementia.

This article explains ME/CFS and fibromyalgia brain fog, the mechanisms behind them, and how medications and other treatments can help clear the fog.

Symptoms of Brain Fog

Symptoms of fibro fog or ME/CFS brain fog differ from person to person and can range from mild to severe. They frequently vary from day to day, and not everyone has all of them.

Executive Function Deficits

Executive function is a higher-level cognitive ability involving:

• Planning
• Attention
• Problem-solving
• Working memory
• Emotional regulation
• Decision-making

Though executive function deficits have been reported in both fibromyalgia and ME/CFS some ME/CFS research disagrees.

These deficits may play a role in many of the cognitive problems associated with these conditions.

Memory Problems

Memory problems are an extremely common issue in fibromyalgia and ME/CFS. These seem to primarily involve short-term and working memory, but other types of memory may be affected as well.

Short-Term and Working Memory

Short-term memory is the ability to temporarily store a small amount of information. That may be something like a short set of instructions or a phone number.

Working memory is the ability to process, manipulate, and use information in your short-term memory. This involves your brain's executive function.

So, executive dysfunction could help account for working memory problems, which have been noted in both conditions.

With these memory issues, you may frequently forget things like:

• The next step in a recipe
• Why you entered a room
• Something you just heard

It can also be hard to learn new information.

ME/CFS and Other Memory Deficits

Some ME/CFS brain fog research has pointed to problems with several other types of memory. These include:

• Visuospatial memory: Deals with perceptions of your orientation in space (where you are in relation to other objects) and the ability to navigate (get from one place to another).
• Episodic verbal memory: A component of long-term memory that involves remembering and recalling what someone said.
• Visual memory: The ability to remember things you've seen.

These deficits may explain ME/CFS brain fog symptoms such as:

• Directional disorientation
• Suddenly not knowing where you are or not recognizing familiar surroundings
• Forgetting how to get to a well-known place
• Not remembering a recent conversation

The Role of Depression in Memory Deficits

If you have depression, it may cause or exacerbate these problems. A 2021 study looked at the possible role of depression in memory issues of fibromyalgia and other chronic pain conditions.

In people with other chronic pain conditions, the problem appeared to come from depression, not the pain. However, in fibromyalgia, pain intensity appeared to make memory problems worse.

Similar findings were reported in a 2018 study.

Attention Deficits and Cognitive Inhibition

Medically speaking, attention is the ability to focus on certain things in your environment and filter out other things. This could mean listening to a teacher while tuning out the students talking behind you.

Some research, including a 2022 study, suggests ME/CFS involves problems with attention. The same issue has been found in fibromyalgia brain fog, with some noting deficits specifically in visual attention.

Symptoms of attention deficits include:

• Inability to focus or concentrate
• Being easily distracted
• Forgetfulness
• Regularly misplacing things
• Lack of attention to detail
• Difficulty with organization
  

These symptoms can lead to problems with learning, much as they do in ADHD (attention deficit hyperactivity disorder.)

Some researchers suspect that pain, fatigue, and the need to constantly monitor your symptoms may prevent you from effectively directing your attention to things outside of yourself. This may help explain:

• Distractibility
• Slow information processing
• Using more effort to perform routine cognitive processes

Cognitive Inhibition

The filtering ability that's involved in attention is called inhibition. It "edits out" unimportant things in your environment so you can focus on those that are more important.

Some fibromyalgia and ME/CFS research has focused on inhibition because it's common for people with the conditions to "tune out" background noise, pain, and other sensory input. Deficits have been noted in both conditions.

One fibromyalgia study involved a simple mental task followed by a difficult mental task. People with fibromyalgia were compared to healthy people in a control group.

Researchers found the participants with fibromyalgia:

• Were significantly slower at completing both tasks
• Had normal pain inhibition while completing the simple task
• Felt more pain while completing the difficult task

Researchers noted differences in brain activity in the fibromyalgia group, as well. At least two regions—the hippocampus and caudate nucleus—showed less activation than in the control group.

Word Use and Recall

One of the more common complaints of people with fibro fog or ME/CFS brain fog is a language deficit that involves:

• Difficulty coming up with known words
• Substituting with incorrect words
• Slow recall of names for people and items (called nominal dysphasia)

One study showed that people with fibromyalgia had slow word recall and that they also had deficits in other areas of cognitive measurement.

Recognizing Facial Expressions

A 2021 study suggests that fibromyalgia brain fog may impair your ability to recognize facial expressions that show emotions.

Participants with fibromyalgia were less able to classify facial expressions that showed:

• Happiness
• Sadness
• Anger
• Fear
• Surprise
• Disgust

Recognizing these expressions is a complex mental process that involves executive function. Researchers believe deficits in executive function are responsible for this inability.

Comparing Fibro Fog and ME/CFS Brain Fog

While fibromyalgia and ME/CFS are different conditions, they're closely related and have a lot in common. However, their cognitive dysfunction symptoms appear to be somewhat different.

A 2016 study suggested that:

• People with both fibromyalgia and ME/CFS had more cognitive impairment than those with ME/CFS alone.
• People with only ME/CFS appeared to have more problems with visual perception.
• People with more pain (from either or both conditions) had a harder time remembering what they heard.
• In people with only ME/CFS, more pain appeared to be linked to slower reaction times.
  

Central Sensitization

One research team explored the connection between cognitive ability and central sensitization—an overly sensitive central nervous system.

Central sensitization is believed to be a key underlying feature of fibromyalgia, ME/CFS, and related conditions such as migraine and irritable bowel syndrome.

They found that cognitive impairment appeared to be linked to:

• Central sensitization
• Impaired pain processing (a known feature of both conditions)
• Hyperalgesia (amplified pain, a known feature of both conditions)
• Lower health-related quality of life

Multitasking Difficulties

Multitasking is performing more than one activity at a time or switching rapidly between activities. It relies on executive function and cognitive inhibition.

Both fibromyalgia and ME/CFS can impair your ability to multitask. You may not be able to pay attention to more than one thing, or you may forget aspects of the original task when trying to switch to another.

Some researchers believe this may be linked to internally directed attention, which impairs your ability to pay attention to external factors in your environment—and especially multiple external factors.

Causes of ME/CFS and Fibromyalgia Brain Fog

Researchers have a lot of theories about things that may contribute to fibro fog and ME/CFS brain fog, including:

• Pockets of inflammation in the brain
• Sleep that isn't restful or restorative
• Mental distraction due to pain and/or fatigue
• Overexertion in ME/CFS as a consequence of post-exertional malaise
• Medications for fibromyalgia and ME/CFS
• Low blood flow to areas of the brain related to attention
• Abnormal connectivity patterns between different regions of the brain
• Abnormal function of certain brain chemicals (neurotransmitters)
• Premature aging of the brain (loss of gray matter volume)
• Comorbid depression

In fibromyalgia, brain fog generally is worse when pain is worse. In both fibromyalgia and ME/CFS, cognitive dysfunction can be exacerbated by fatigue, anxiety, stress, or sensory overload.

Brain Fog Treatment

If you're concerned about your mental abilities, talk to your healthcare provider. You can have cognitive testing to:

• Identify your problems
• Determine your level of dysfunction
• Monitor your dysfunction over time to see if treatments are helping

Proper testing and treatment could help you function better.

For some people, fibro or ME/CFS brain fog resolves when pain or sleep problems are effectively treated.

Common medications for these conditions, which may improve brain fog, include:

• Lyrica (pregabalin)
• Cymbalta (duloxetine)
• Savella (milnacipran)
• Amitriptyline
• Neurontin (gabapentin)
• Ritalin (methylphenidate)

If you need additional help with sleeping, your healthcare provider may prescribe:

• Ambien (zolpidem)
• Lunesta (eszopiclone)
• Sonata (zaleplon)

You may also be sent for a sleep study to see whether you have any sleep disorders.

These medications don't help everyone with fibromyalgia and ME/CFS. Be sure to tell your healthcare provider what treatments do and don't work for you.

Supplements for Brain Fog

While there's little evidence to support their use, some healthcare providers and people with these conditions believe supplements may help improve cognitive function in fibromyalgia and ME/CFS.

Common supplements for this include:

• 5-HTP
• B vitamins
• Carnitine
• Choline
• Iodine
• Iron
• Omega-3 (fish oil)
• Rhodiola rosea
• St. John's wort
• SAM-e
• Theanine
• Vitamin D

Talk to your healthcare provider before taking any supplements. They can help determine whether it's the right treatment for you and won't have negative interactions with other medications or supplements you're taking.

Food for Combatting Brain Fog

Some healthcare providers recommend dietary changes to include foods that are natural sources of the supplements listed above.

Some of these foods are:

• Fish (omega-3)
• Canola or walnut oil (omega-3)
• Fruits and vegetables (various nutrients and antioxidants)
• Black or green tea (theanine)
• Eggs (choline)

Some research suggests that a Mediterranean diet can lead to better cognitive function. This diet emphasizes:

• Fruits and vegetables
• Whole grains
• Fish and seafood
• Olive oil
• Seeds
• Eggs
• Cheese
• Poultry

A few studies have been done on this diet for fibromyalgia. So far, none has focused on cognitive symptoms, but one noted improvements in fatigue and depression—both of which may contribute to fibro fog.

Exercise and Brain Fog

These conditions, especially ME/CFS, have a complex relationship with exercise. It can both help and harm.

When it comes to exercise and cognitive function, there may be a benefit:

• Some fibromyalgia research shows that moderate exercise can help improve working memory and alleviate depression.
• ME/CFS research suggests exercise may improve visual attention, reaction times, and processing speed.

However, in the ME/CFS study, the benefits were only seen in a small number of study participants. Some people simply didn't respond to exercise. Many others couldn't or wouldn't complete the program due to post-exertional malaise (PEM).

PEM is a defining symptom of ME/CFS. It means that even mild exertion can lead to symptom flares that may last for days or weeks.

The fibromyalgia response to exercise is less extreme, but it can also cause a symptom flare if you do too much.

You should only attempt an exercise program with help from your healthcare provider. Even then, it must be tailored to your fitness level and ability to tolerate exercise.

Cognitive Training

Research on aging brains and some degenerative brain conditions shows that cognitive training can slow, stop, or sometimes even reverse cognitive dysfunction.

Some healthcare providers use cognitive training programs that may include software that you use at home. Video game companies and websites offer games they claim can improve cognitive function, as well.

Specific games haven't been evaluated for improving cognitive function. However, some evidence does suggest that virtual reality games improve memory and critical thinking skills.

Because this is an emerging area of science, researchers are likely to learn more about cognitive training in the years ahead.

Summary

Fibro fog and ME/CFS brain fog can include deficits in executive function, several types of memory, attention, and cognitive inhibition. Symptoms include forgetfulness, confusion, directional disorientation, and word-recall problems.

Cognitive symptoms may be caused by numerous physical abnormalities tied to these conditions. Some of them are neuroinflammation, non-restorative sleep, post-exertional malaise, and comorbid depression.

Medications, supplements, dietary changes, and specially tailored exercise may help improve symptoms of fibro fog and ME/CFS brain fog.

A Word From Verywell

Cognitive dysfunction can be tough to live with. However, working with your healthcare provider to find the right mix of treatments can help you overcome the deficits caused by your illness.

Meanwhile, talk to the people in your life about your cognitive dysfunction and how it affects you. They may be able to help with things that are difficult for you or just offer understanding. Either of those can be a big help.