Hulens, Mieke, Dankaerts, Wim, Rasschaert, Ricky et al. · Journal of pain research · 2023 · DOI
This review explores a possible connection between three conditions—empty sella syndrome, fibromyalgia, and ME/CFS—that may all involve increased pressure from cerebrospinal fluid around the brain and pituitary gland. The authors found that these conditions share similar symptoms (fatigue, pain, headaches, vision problems) and similar hormone imbalances, suggesting that fluid pressure problems might be a common underlying cause worth investigating further.
This study proposes a testable biological mechanism—CSF pressure dysregulation—that could unify understanding of HPA axis dysfunction in ME/CFS and fibromyalgia. If validated, this hypothesis could redirect research toward identifying and potentially treating elevated intracranial pressure as a treatable feature, rather than viewing these conditions as purely functional or psychiatric.
This is a narrative review, not original research, so it does not provide new experimental data or establish causation between CSF pressure and ME/CFS or fibromyalgia symptoms. The review identifies associations and overlapping features but cannot prove that CSF pressure dysregulation is the primary cause rather than a secondary effect or coincidental finding in some patients.
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, Dankaerts, Wim, Rasschaert, Ricky, Bruyninckx, Frans, De Mulder, Peter, & Bervoets, Chris (2023). The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure.. Journal of pain research. https://doi.org/10.2147/JPR.S394321
BibTeX
@article{mecfsatlas-hulens-2023-link-between,
author = {Hulens, Mieke and Dankaerts, Wim and Rasschaert, Ricky and Bruyninckx, Frans and De Mulder, Peter and Bervoets, Chris},
title = {The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure.},
journal = {Journal of pain research},
year = {2023},
doi = {10.2147/JPR.S394321},
note = {PubMed: 36721849},
url = {https://www.mecfsatlas.com/evidence/hulens-2023-link-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/hulens-2023-link-between
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