Hulens, Mieke, Rasschaert, Ricky, Vansant, Greet et al. · Journal of pain research · 2018 · DOI
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.
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.
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.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Hulens, Mieke, Rasschaert, Ricky, Vansant, Greet, Stalmans, Ingeborg, Bruyninckx, Frans, & Dankaerts, Wim (2018). The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology.. Journal of pain research. https://doi.org/10.2147/JPR.S186878
BibTeX
@article{mecfsatlas-hulens-2018-link-between,
author = {Hulens, Mieke and Rasschaert, Ricky and Vansant, Greet and Stalmans, Ingeborg and Bruyninckx, Frans and Dankaerts, Wim},
title = {The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology.},
journal = {Journal of pain research},
year = {2018},
doi = {10.2147/JPR.S186878},
note = {PubMed: 30573989},
url = {https://www.mecfsatlas.com/evidence/hulens-2018-link-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/hulens-2018-link-between
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