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ME/CFS Atlas — A public knowledge atlas for ME/CFS

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ME/CFS Atlas is an evidence reference platform, not a medical provider. Content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

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ME/CFS Evidence Browser — Classified Studies on Myalgic Encephalomyelitis

Evidence browser

Search and filter 6,145 studies by evidence level, diagnostic criteria, PEM status, and research domain. Each entry links to the original source.

Studies sorted by evidence level, then year. Browse by topic instead →

Evidence level (E0–E3) reflects study type and replication, not methodological quality. A weak systematic review still sits at E0. How evidence levels work →

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345 studies

E0 — Consensus637E1 — Replicated320E2 — Moderate2,768E3 — Preliminary2,420

ME/CFS4,014Long COVID212Post-infectious189Overlapping1,045

Required for diagnosis412Not specified / unclear2,201Not required3,532

Post-Exertional Malaise1,055Cognitive Dysfunction1,723Pain1,612Unrefreshing Sleep793Orthostatic Intolerance474

Cytokines816Gene Expression567Metabolomics469Neuroimaging466Autoantibodies457

Infection-Triggered1,170Long COVID Overlap580Pediatric492Severe228

Strong Phenotyping435Sex-Stratified326Severe ME Included116

Systematic Review263Meta-Analysis60RCT300

Peer-reviewed6,088Preprint3Unclear54

301–320 of 345 studies

E3 PreliminaryBehavioralPEM not requiredObservational

Orthostatic panic attacks among Vietnamese refugees.

Hinton, Devon E, Hinton, Ladson, Tran, Minh et al.·Transcultural psychiatry·2007

This study looked at Vietnamese refugees who experienced panic attacks triggered by standing up quickly from a sitting or lying position (orthostatic dizziness). The researchers found that these panic attacks were common among this group and were often linked to trauma memories and cultural beliefs about health. The study suggests that doctors treating Vietnamese refugees should check for and treat these specific panic attacks as part of their care.

Autonomic Nervous System

E3 PreliminaryMechanismPEM not requiredObservational

[Evaluation of fatigue by using acceleration plethysmography].

Yamaguti, Kouzi·Nihon rinsho. Japanese journal of clinical medicine·2007

Researchers tested a new device called acceleration plethysmography to measure fatigue in ME/CFS patients. This device tracks tiny blood vessel changes and nervous system activity in the fingertip. The study found that fatigue levels were connected to specific patterns in these measurements, suggesting this tool might help doctors objectively measure ME/CFS fatigue in the future.

Autonomic Nervous System

E3 PreliminaryMechanismPEM unclearCross-Sectional

Abnormal thermoregulatory responses in adolescents with chronic fatigue syndrome: relation to clinical symptoms.

Wyller, Vegard Bruun, Godang, Kristin, Mørkrid, Lars et al.·Pediatrics·2007

This study looked at how the body controls temperature in adolescents with ME/CFS compared to healthy teenagers. Researchers found that people with ME/CFS have abnormal responses to temperature changes, with their bodies struggling to regulate heat and cold properly. The study suggests this problem may be related to dysfunction in the nervous system's control of stress hormones like adrenaline.

Autonomic Nervous System

E3 PreliminaryCohortPEM not requiredCase-Control

Sympathomimetic amine therapy may improve refractory gastroparesis similar to its effect on chronic pelvic pain--case report.

Boimel, P, Check, J H, Katsoff, D·Clinical and experimental obstetrics & gynecology·2007

This case report describes one patient with ME/CFS who had severe stomach emptying problems (gastroparesis) that didn't respond to standard treatments. When she was given a stimulant medication called dextroamphetamine, her stomach symptoms improved significantly and stayed better for at least eight months. The authors suggest this type of medication might help some people with refractory gastroparesis, similar to how it may help other ME/CFS-related symptoms.

Autonomic Nervous System

E3 PreliminaryReviewPEM not requiredReview-Narrative

[School phobia and childhood chronic fatigue syndrome (CCFS)].

Tomoda, Akemi·Nihon rinsho. Japanese journal of clinical medicine·2007

This review examines childhood chronic fatigue syndrome (CCFS), a serious condition where children experience extreme tiredness that cannot be explained by other medical or mental health problems. Children with CCFS often struggle with memory and concentration, sleep problems, and symptoms related to their nervous system. The authors suggest that CCFS may involve changes in how the brain functions, which could explain why patients experience fatigue, thinking difficulties, and memory problems.

Autonomic Nervous SystemCognitive Impairment

E3 PreliminaryCohortPEM not requiredCase-Control

Treatment of chronic fatigue and orthostatic intolerance with propranolol.

Wyller, Vegard Bruun, Thaulow, Erik, Amlie, Jan P·The Journal of pediatrics·2007

This study looked at a teenager with ME/CFS who also experienced dizziness and fainting when standing up (orthostatic intolerance). The doctors treated this teen with propranolol, a blood pressure medication that slows the heart rate. The case suggests that an overactive stress-response system in the nervous system might contribute to ME/CFS symptoms, and that a simple tilt test could help identify patients who might benefit from this type of treatment.

Autonomic Nervous System

E3 PreliminaryMechanismPEM not requiredMechanistic

Cardiovascular systemic regulation by plantar surface stimulation.

Madhavan, Guruprasad, Stewart, Julian M, McLeod, Kenneth J·Biomedical instrumentation & technology·2006

This study tested whether gentle vibrations applied to the bottom of the foot could help stabilize blood pressure and heart rate when people sit down. Researchers found that vibrations at a specific frequency (around 44 Hz) significantly reduced the normal drop in blood pressure that occurs with sitting, and were especially helpful for people whose blood pressure drops excessively.

Autonomic Nervous System

E3 PreliminaryDiagnosticPEM not requiredMethods-Paper

Search for disease-specific cardiovascular reactivity patterns: developing the methodology.

Naschitz, Jochanan E, Rozenbaum, Michael, Fields, Madeline et al.·Clinical science (London, England : 1979)·2005

Researchers developed new methods to detect specific patterns in how the body's heart rate and blood pressure respond to physical stress (tilting upright) in people with familial Mediterranean fever (FMF). They found that people with FMF show distinctive cardiovascular responses that can be measured and used to help identify the condition. The study shows this approach might also work for other diseases, including ME/CFS.

Autonomic Nervous System

E3 PreliminaryCohortPEM not requiredCase-Control

Midodrine treatment for chronic fatigue syndrome.

Naschitz, J, Dreyfuss, D, Yeshurun, D et al.·Postgraduate medical journal·2004

This study reports on one patient with severe ME/CFS who was treated with midodrine, a medication that helps regulate blood pressure and heart rate control. The patient's symptoms of dysautonomia (problems with the autonomic nervous system that controls automatic body functions) improved with this treatment, and their fatigue also improved. This suggests that treating the autonomic nervous system dysfunction may help some people with ME/CFS feel better.

Autonomic Nervous System

E3 PreliminaryMechanismPEM not requiredObservational

The effect of brief exercise cessation on pain, fatigue, and mood symptom development in healthy, fit individuals.

Glass, Jennifer M, Lyden, Angela K, Petzke, Frank et al.·Journal of psychosomatic research·2004

This study looked at whether stopping exercise for just one week could trigger pain, fatigue, or mood problems in healthy people who exercise regularly. Researchers found that 8 out of 18 fit volunteers developed these symptoms after a week without exercise, and these people had weaker stress-response systems (measured by cortisol levels, immune cells, and heart rate patterns) at the start of the study. This suggests some healthy people may naturally have less active biological stress systems and may actually rely on regular exercise to keep their symptoms suppressed.

Autonomic Nervous SystemImmune System

E3 PreliminaryReviewPEM unclearReview-Narrative

Physiology and pathophysiology of the 5-HT3 receptor.

Färber, L, Haus, U, Späth, M et al.·Scandinavian journal of rheumatology. Supplement·2004

This review examines how a specific brain chemical receptor called 5-HT3 works in the body and what happens when it malfunctions. The researchers found that blocking this receptor with certain medications may help treat several conditions, including ME/CFS, by reducing symptoms like nausea, pain, and anxiety. However, scientists still don't fully understand exactly how this receptor causes problems in these different illnesses.

Pain and SensitizationAutonomic Nervous System

E3 PreliminaryReviewPEM not requiredReview-Narrative

Fainting freshmen and sinking sophomores: cardiovascular issues of the adolescent.

DiVasta, Amy Desrochers, Alexander, Mark E·Current opinion in pediatrics·2004

This review article explains that fainting is common in teenagers, but most cases are not caused by serious heart problems. Doctors can identify the few teenagers with real heart disease using a detailed patient history, physical examination, and an electrocardiogram (ECG). The article emphasizes that teenagers with certain conditions—including chronic fatigue syndrome, eating disorders, and exercise-related fainting—need extra careful evaluation because their heart problems may be more serious or harder to manage.

Autonomic Nervous System

E3 PreliminaryReviewPEM not requiredReview-Narrative

Dysautonomia in chronic fatigue syndrome: facts, hypotheses, implications.

Naschitz, Jochanan E, Yeshurun, Daniel, Rosner, Itzhak·Medical hypotheses·2004

This study looked at whether people with ME/CFS have problems with their autonomic nervous system—the part that automatically controls heart rate and blood pressure. Researchers found a distinctive pattern of dysautonomia (autonomic dysfunction) in ME/CFS patients that differs from other conditions, and they developed two scoring systems to help identify it. A small pilot study suggested that treating this dysautonomia with a medication called midodrine improved both the autonomic problems and fatigue symptoms.

Autonomic Nervous System

E3 PreliminaryMechanismPEM not requiredMechanistic

Acetylcholine mediated vasodilatation in the microcirculation of patients with chronic fatigue syndrome.

Spence, V A, Khan, F, Kennedy, G et al.·Prostaglandins, leukotrienes, and essential fatty acids·2004

This study looked at how blood vessels in ME/CFS patients respond to acetylcholine, a chemical messenger in the body. Normally, blood vessels become less responsive to acetylcholine in disease, but researchers found the opposite in ME/CFS patients—their blood vessels were unusually sensitive to it. This unusual sensitivity might help explain why many ME/CFS patients experience problems with blood flow and circulation.

Autonomic Nervous System

E3 PreliminaryReviewPEM unclearReview-Narrative

The head-up tilt test in the diagnosis and management of chronic fatigue syndrome.

Naschitz, Jochanan E, Sabo, Edmond, Dreyfuss, Daniel et al.·The Israel Medical Association journal : IMAJ·2003

This review examines how a simple test called the head-up tilt test might help diagnose and manage ME/CFS. In this test, a patient lies flat and is then tilted upright while doctors measure heart rate and blood pressure changes. The review discusses whether these measurements could reveal problems with how the body controls blood pressure and heart function in ME/CFS patients.

Autonomic Nervous System

E3 PreliminaryMechanismPEM not requiredCross-Sectional

Cerebral and systemic hemodynamics changes during upright tilt in chronic fatigue syndrome.

Razumovsky, Alexander Y, DeBusk, Karen, Calkins, Hugh et al.·Journal of neuroimaging : official journal of the American Society of Neuroimaging·2003

When people with ME/CFS stand up quickly, they often experience dizziness and fainting. This study used ultrasound to measure blood flow in the brain during a tilt test and compared it between ME/CFS patients and healthy people. The researchers found that blood flow patterns in the brain were actually similar between the two groups, even though ME/CFS patients felt symptoms faster.

Autonomic Nervous System

E3 PreliminaryCohortPEM not requiredCase-Control

Case reports and review of Postural Orthostatic Tachycardia syndrome (POTS).

Carothers, Becky, Schmidt, Lori, Puri, Vinay·The Journal of the Kentucky Medical Association·2003

POTS is a condition where your heart rate increases too much when you stand up, and less blood flows to your brain, causing dizziness and fainting. This paper describes two patients with POTS who needed different levels of treatment—one managed at home and one needing hospital care. The authors point out that POTS is probably more common than doctors realize and is sometimes mistaken for chronic fatigue syndrome or other conditions.

Autonomic Nervous System

E3 PreliminaryBehavioralPEM not requiredCase-Control

Chronic fatigue syndrome and eating disorders: concurrence or coincidence?

Fisher, Martin, Krilov, Leonard R, Ovadia, Marc·International journal of adolescent medicine and health·2002

This study looked at four adolescent patients who had both an eating disorder and ME/CFS at the same time. In all four cases, the eating disorder appeared first, followed later by ME/CFS symptoms. The authors explored whether these two conditions might be related through common causes, whether an eating disorder could trigger ME/CFS, or whether they simply occurred together by chance.

Autonomic Nervous System

E3 PreliminaryReviewPEM not requiredReview-Narrative

Chiari type I malformation revisited: diagnosis and treatment.

Cheng, Joseph S, Nash, John, Meyer, Glenn A·The neurologist·2002

Chiari type I is a condition where brain tissue (cerebellar tonsils) extends into the spinal canal, potentially compressing the lower brain and upper spinal cord. This article reviews how doctors diagnose and treat this condition, and discusses possible links between Chiari I and ME/CFS, fibromyalgia, and other neurological symptoms. The authors note that in severe cases, Chiari I can cause permanent nerve damage, but better imaging and treatments are being developed.

Autonomic Nervous System

E3 PreliminaryReviewPEM unclearReview-Narrative

The chronic fatigue syndrome is a disease of the autonomic nervous system. Sometimes.

Freeman, Roy·Clinical autonomic research : official journal of the Clinical Autonomic Research Society·2002

This review article examines whether ME/CFS might be caused by problems with the autonomic nervous system—the part of your body that controls automatic functions like heart rate and blood pressure. The author, Dr. Roy Freeman, discusses evidence suggesting that some ME/CFS patients do show signs of autonomic dysfunction, but emphasizes that this is not true for all patients with the condition.

Autonomic Nervous System

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PEM Immune Neuro Metabolic Biomarkers Severe ME Long COVID Cognitive

Curated Collections

Thematic groupings by clinical question or research area.

Neuroinflammation Evidence

PET imaging and other studies providing evidence for brain inflammation in ME/CFS.

Metabolism & Mitochondria

Metabolomics and mitochondrial function studies revealing energy metabolism disruption.

Biomarkers

Studies identifying potential biological markers for ME/CFS diagnosis and stratification.

PEM-Specific Research

Studies specifically examining post-exertional malaise, the hallmark symptom of ME/CFS.