What Causes Fibromyalgia to Flare-up?

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How to Escape Fibro Flare-Up Triggers

About a year ago, shortly after I turned 50, my doctor told me that I may have fibromyalgia.

I was experiencing joint pains, brain fog, and fatigue, but I tested negative for RH.

When I asked him if FM could be causing some other problems, he told me this about the condition: “Frankly, we don’t know much about fibromyalgia. But probably not.”

Why does information about Fibromyalgia always seem so vague?

For 30 years we have had a word, an unclassified syndrome, and a whole lot of patients. ‘2-8%’ of the population is said to have FM (sometimes it is said to be 2-5%), and that statistic seems to be global.

Nonetheless, medical science still hasn’t had a lucky break with finding causes or cures for fibromyalgia, and patients report a vast range of symptoms.

Most doctors aren’t comfortable going out on a limb to assert their personal opinions about FM, if they have any, as the syndrome is likely to be broken down into manageable categories with definable causes in the not too distant future. As it stands today, even a definitive diagnostic protocol has not been agreed upon.

In this article, we looked closely at patients’ descriptions of their experiences in addition to medical research. The contents herein are not intended as a replacement for medical advice.

Fibromyalgia is a syndrome without a beginning, middle, or end:

Studying FM can be maddening. Most syndromes have a classification, but fibromyalgia doesn’t.

Wikipedia states that in the US FM is classified as a ‘functional somatic disorder’, while in Europe it is classified as a ‘neurological syndrome’.

There aren’t any defined sub-types of FM. There isn’t a blood test and even the famous ‘pressure point chart’ has been deemed unreliable.

The Fibro Institute recently published a statement about the current diagnostic test. In it, they refer to the American College of Rheumatology’s new diagnostic criteria, which is in the form of a simple questionnaire.

FM is not curable and the symptoms, which come and go in mysterious flare-ups, are difficult to control. It is not degenerative, although some people experience worsening symptoms.

Managing flare-ups is today’s main line of defense.

The cause of fibromyalgia remains unclear. Several genes may be involved. Some families may have an unusually high instance of FM, while others probably don’t; as the term Fibromyalgia wasn’t defined until between 1976 and 1982, it’s hard to tell.

The National Institute of Health explains that the history of FM has consisted of a long series of studies and debates.

To make things even more complicated, FM is very frequently co-morbid with other conditions, particularly chronic fatigue syndrome, TMJ, and irritable bowel syndrome.

Anxiety and depression are common to FM sufferers but it is unclear whether these mood disorders are causes, symptoms, or results of FM.

Some medical professionals try to stuff all of their FM patients into the same box. This is my attempt to clarify what Wikipedia explains so well:

From Wikipedia:

“Neurologists and pain specialists tend to view fibromyalgia as a pathology due to dysfunction of muscles and connective tissue[…]Rheumatologists define the syndrome in the context of “central sensitization” […]psychiatrists often view fibromyalgia as a type of affective disorder […]specialists in psychosomatic medicine tend to view fibromyalgia as being a somatic symptom disorder[…]”


Alternative western medicine sees fibromyalgia as one of several autoimmune disorders caused by environmental toxicity and points out that the great variation found in FM symptoms is explained by this.

Naturopathic therapy includes special diets, supplements, and avoiding environmental toxins.

Serum tests find that fibromyalgia patients are frequently deficient in certain minerals, particularly magnesium and the vitamin B series. FM patients have reported having very good results with this sort of therapy.

Linda Mocksuund, ND explains the naturopathic view of FM as a holistic concept involving our body’s reaction to toxins and stress.

What triggers the initial fibromyalgia flare-up?

Fibromyalgia is said to be ‘triggered’ when it first becomes severe enough to be diagnosed.

It is also ‘triggered’ periodically after the initial attack, as most sufferers have ‘remission’ periods during which they feel better, as well as good and bad days.

member of prohealth.com’s fibromyalgia forum eloquently describes her experiences with FM and its unpredictable cycles in a “Letter to Normals” which discusses the frustrations of being able to participate in an activity one day and not the next.

FM usually has a dramatic onset. Many patients report that they had had mild symptoms of FM long before their first major episode but had attributed aches, pains, fatigue, and occasional brain fog to aging.

There is general agreement that the condition lies dormant in people that are, for whatever reason, susceptible to it. A sudden episode may accompany a major illness or personal loss, although FM sometimes manifests without any apparent cause.

What types of flare-ups happen to people with fibromyalgia?

Many patients report experiencing both flare-ups similar to their first episode and also flare-ups of individual symptoms. For example, wearing a new pair of shoes might trigger intense foot and leg cramps and aches without accompanying fatigue and depression.

What causes major flare-ups in fibromyalgia?

Some fibromyalgia patients go for months without an episode as severe as their first one, and some report going for years.

People with FM are quickly reminded that they have the condition if they stop taking their medications, slip from their diet, or allow other triggers into their lives.

There are many reports of unexpected exposure to toxins triggering major flare-ups.

Examples include spending time in a moldy environment, nearby fires, and faltering from a diet or regime that seems to work for the individual.

According to the fibro forum on ProHealth.com forum, even flu shots have been noted to cause flare-ups.

Stress can also trigger major episodes, particularly in patients with PSTD. No one can prevent all stressful life events, but the management of FM requires avoiding places and activities that the individual finds upsetting if possible. Medication for anxiety is important in treating fibromyalgia flare-ups.

People with FM find that they need to identify their stressors, which may vary a great deal.

Sleep ‘hygiene’ is important in controlling FM, according to Surely Roizenblatt, Nilton Salles, Rosa Neto, and Sergio Tufik, courtesy of Springerlink.com.

Symptoms such as cramps and stiffness frequently worsen overnight, causing people to feel even more tired during the day.

Sleep therapies are recommended in the treatment of most FM, although a simple sleeping medication may suffice for some people.

Patients that take several conventional medicines to control their various symptoms have problems with developing tolerances and needing to change medicines occasionally. This almost always triggers major flare-ups.

fibro Temperature intolerance

Temperature intolerance can cause minor flare-ups:

Strange feelings of being hot and cold simultaneously, or very cold and then very hot in rapid cycles, are frequently reported in FM.

Changes in the weather, room temperature, and even massages that use heat then chill method, may trigger this, as also muscle and joint pain. A dip in a cold pool on a hot day is torture for many FM sufferers.

Being suddenly chilled can cause a feeling of fever for a period afterward, or other strange sensations, such as a burning feeling in the bones or ice-cold hands with an overheated torso, are common in fibromyalgia according to Grant Hughs, MD.

Brief exposure to environmental toxins may cause small flare-ups:

As above, environmental triggers such as nearby fires and mold can trigger minor FM episodes as well as major ones.

For example, a few hours in a home with a mold problem might cause allergy-like symptoms and general malaise for the rest of the day, as can fire burning nearby. 10

A bad night’s sleep is notorious for causing flare-ups:

Loss of sleep, jet lag, or forgetting sleep medications can trigger minor FM flare-ups, particularly fatigue, pain, and brain fog.

However, one patient notes that “people with FM really can catch up on sleep”. A bad night can trigger many symptoms that are relieved by a day of rest.

Flare-ups of fibro fog may be partly due to stressors:

While periodic ‘brain fog’ happens to most people with FM, some people report that stressful situations can trigger it.

Brain fog is so prevalent in FM sufferers that the Arthritis Foundation names it ‘Fibro Fog’.

Social or business events that cause stress aren’t always avoidable. Declining every invitation and not managing personal finances can lead to isolation and fiscal damage, which is in itself stressful. Therapy can help with this and other issues related to FM.

What about joint, tendon, and muscle pain flare-ups?

Exercise, even at a level that seems quite gentle to ‘normal’ people, can trigger extreme pain. Even swimming can cause extreme soreness.

The frequent recommendations of yoga and other exercise routines make some people with FM feel misunderstood.

Poor posture can also contribute to pain. Wearing a back brace during the day can be helpful.

People exhausted by FM often find themselves slouching or slumping, causing back and torso pain.

Dr. Steven Weiniger states that posture is critical in controlling back pain in patients with FM.

How are other symptomatic flare-ups of fibromyalgia prevented?

Dizzy spells, tinnitus, numbness, tingling, and inexplicable sharp pains are hard to control. Patients report that spells seem to come out of nowhere.


With much research and a little luck, this article may become obsolete as science finds more definitive answers about fibromyalgia.

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