Signs of a Fibromyalgia Flare-Up

Fibromyalgia is characterized by widespread areas of pain. Tender points, stiffness, fatigue, sleep disturbances and other symptoms are also common. Flare-ups occur when fibromyalgia symptoms worsen. They may appear for no apparent reason or they may be triggered by certain things or events.

If you have fibromyalgia, you are not alone. The National Fibromyalgia Association estimates that about 10 million in the United States suffer from this condition 4. Fibromyalgia is a chronic disorder characterized by widespread pain in multiple areas of the body. Tender points, stiffness, fatigue, sleep disturbances and other symptoms are also common. The exact cause has not been determined, but fibromyalgia sometimes runs in families.

The symptoms of fibromyalgia often vary from day to day 3. Flare-ups occur when symptoms worsen. Sometimes the flare-ups appear for no apparent reason. At other times, they are triggered by certain things or events. Common triggers include cold or humid weather, inadequate sleep, physical stress, emotional stress and physical inactivity.


Widespread pain is the main symptom of fibromyalgia 2. To be diagnosed as fibromyalgia, the pain must occur in various locations on both sides of the body, as well as above and below the waist. Low back pain is common. During flare-ups, the pain worsens. The pain may be felt as a deep muscular aching sensation accompanied by shooting pains.

Tender Points and Stiffness

Tender points and stiffness are other features of fibromyalgia that may worsen during flare-ups. Tender points are unusually sensitive areas located in specific parts of the body. People with fibromyalgia will develop severe pain when only mild pressure is applied to these areas. Stiffness is often worse in the morning and improves during the day.

Fatigue and Sleep Disturbances

People with fibromyalgia often have varying energy levels, but fatigue is common. During flare-ups, fatigue can be especially severe.

Sleep disturbances often worsen during flare-ups and contribute to the fatigue. Difficulty getting to sleep is common. People with fibromyalgia may also have episodes of "awake-like" brain activity during the night when they should be entering deep, stage 4 sleep, according to a Medscape continuing medical education article 6. Without adequate stage 4 sleep, a person will wake up in the morning feeling unrefreshed.

Other Signs

Individuals with fibromyalgia may experience a wide variety of other symptoms, which can also worsen during flare-ups. These include headaches, memory problems, difficulty concentrating, anxiety and depression. The headaches often feel like migraines.

Flare-ups tend to be less severe or less frequent with adequate treatment of fibromyalgia. Talk with your doctor about treatments that may be most appropriate for you. Try to avoid things and events that trigger your flare-ups. Keeping a diary may help identify your triggers.

The American College of Rheumatology advises beginning an exercise program, such as walking, swimming or water aerobics, to reduce flare-ups 15. But overdoing exercise can trigger flare-ups, so be sure to start slow and gradually increase your activity level. Consult your doctor before beginning any new activity.

Reviewed and revised by Mary D. Daley, M.D.