Everyone’s fibromyalgia experience is unique, and what affects one person may not affect another. But there are common factors that tend to influence symptoms, says Mary Ann Fitzcharles, MD, an associate professor of medicine in the division of rheumatology at McGill University in Montreal, who treats people with fibromyalgia.
“We refer to what is the initiating factor. [They] tend to be present when symptoms are … aggravated or heightened,” Dr. Fitzcharles says.
1. Weather Changes
Many people with fibromyalgia report worsening pain and stiffness during changes in temperature or barometric (atmospheric) pressure. “Patients will say, ‘I can forecast the weather much better than the weatherman,'” Fitzcharles says.
Research backs this up: One small observational study of people in a randomized controlled trial found that weather changes — especially a drop in barometric pressure and increases in humidity — may worsen fibromyalgia pain.
2. Cold Temperatures
Some research suggests people with chronic pain conditions are particularly sensitive to cold weather. Cold temperatures have been tied to symptoms like muscle stiffness and joint pain in people with fibromyalgia. Reduced daylight hours in the fall and winter can lead to increased fatigue, low energy levels, and disrupted sleep, all of which can exacerbate symptoms.
Seasonal transitions, such as the transitions into spring and fall, can also be challenging because temperatures fluctuate more frequently between warm and cool, Fitzcharles says.
3. Strong Scents, Bright Lights, and Loud Noises
Research suggests people with fibromyalgia report a greater sensitivity to everyday sensory experiences — including sound, light, smell, taste, and touch — than people without fibromyalgia, suggesting a heightened sensory processing may be a hallmark feature of the condition.
It’s what clinicians call hypervigilance, meaning their nervous system becomes more reactive to sensory input that other people may barely notice, Fitzcharles says. Triggers include flashing or bright lights, strong food odors, or loud background noise.
“This hypervigilance manifests by people saying, ‘I just don’t like it when I’m in a room with lots of noise. Or when the children are making a lot of noise or when the TV is too loud, it disturbs me,’” she says.
4. Poor Sleep
Sleep problems are both a key symptom and a potential amplifier of symptoms in people with fibromyalgia, says Fitzcharles. Polysomnography research (studies conducted in a sleep lab) suggests that the relationship between fibromyalgia and sleep disturbances is likely a two-way street.
5. Physical Overexertion
“Pacing is so important [with exercise], because if somebody overdoes it, sometimes it could be a trigger,” he says. In one study, physical overexertion was one of the most common triggers, affecting 37 percent of 124 survey respondents.
6. Diet
Research on diet and fibromyalgia is emerging and mixed, and there’s no science-backed “fibromyalgia diet” proven to work for everyone, Fitzcharles says. Instead, some people might notice certain foods seem to worsen their symptoms, she says.
A randomized controlled trial of 46 people with fibromyalgia found that following an anti-inflammatory diet that eliminated ultra-processed foods, gluten, dairy, and added sugar for three months and a low-FODMAP phase in the first month led to improvements across pain, fatigue, sleep, and quality of life.
A review published in 2024 found that fiber from fruit, whole grains, vegetables and other plant-based foods, as well as probiotics, might also improve fibromyalgia symptoms by supporting the gut microbiome and reducing inflammation. But the authors of the review noted that the evidence was limited and not yet strong enough for clinical recommendations.
7. Hormonal Fluctuations
Fibromyalgia affects women more often than men. Some women notice worsening symptoms around their menstrual cycle, during perimenopause, or after menopause. “This may be a bit more personal, depending on the woman and her cycle,” Fitzcharles says. Research suggests fibromyalgia symptoms are amplified with the onset of menopause, and symptoms of both conditions may overlap.
8. Illness and Infection
An injury or illness, such as Epstein-Barr virus or Lyme disease, or surgeries or complications from surgeries, can trigger the development of fibromyalgia, and place additional demands on and temporarily worsen symptoms of those who have it.
9. Stress
Emotional stress is one of the most frequently reported symptom aggravators, according to Dr. Lenz. Stress can interfere with sleep, increase muscle tension, and add to a cycle of worsening symptoms, he says. Ongoing and intense stress are among the top factors for symptoms flaring, according to research. It can stem from relationship challenges, caregiving responsibilities, financial worries, or work-related pressures, Lenz says.
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