10 Root Causes of Fibromyalgia

Published January 12, 2026

Medically Reviewed By

Sarah Daglis, ND, MS

Writers

Fibromyalgia is a complex disorder that affects the body, mind, and nervous system. The condition can take years to diagnose, with most patients seeing multiple doctors for confirmation.¹ Although pinpointing a precise cause has eluded healthcare professionals for decades, it’s well known that amplified pain-processing signals in the central nervous system make people with fibromyalgia hypersensitive to pain.²

Widespread chronic pain, fatigue, poor sleep, and brain fog can permeate every part of daily life for people with fibromyalgia. Although there is no single cure, many people find natural, lifestyle-based strategies significantly improve their quality of life when practiced consistently.

Fibromyalgia symptoms and diagnosis

The American College of Rheumatology updated its fibromyalgia diagnostic criteria in 2010, adding a more thorough evaluation of pain levels, a scale to assess fatigue and cognitive symptoms, and references to co-occurring issues such as gastrointestinal problems, memory loss, mental health conditions, and sleep disorders.¹ Although pinpointing a precise cause has eluded healthcare professionals for

“Fibromyalgia can be challenging because it suppresses the hypothalamus, a critical control circuit in the brain,” explains Jacob Teitelbaum, MD, author of the bestselling book From Fatigued to Fantastic. “This causes problems with numerous body systems, including sleep, hormones, and autonomic dysfunction, creating a diverse and complicated constellation of symptoms.”

Many fibromyalgia patients experience fatigue, headaches, and problems with concentration, remembering, and processing information, as well as widespread musculoskeletal pain.³ For some, mental cloudiness, commonly referred to as “fibro fog,” can be even more troublesome than pervasive pain.⁴

About 50% of patients report frequent anxiety and depression.⁵ Other symptoms may include temporomandibular joint disorders, numbness or tingling in the hands and feet, or digestive issues like bloating, constipation, or irritable bowel syndrome.³

10 root causes of fibromyalgia

To identify the causes of fibromyalgia, it’s important to look at the big picture. What’s triggering flare-ups, and do certain sources influence severity more than others?

“When one looks at mitochondrial, hypothalamic, and immune dysfunction, and the associated microglial activation,” says Dr. Teitelbaum, “the seemingly unrelated mix of symptoms suddenly makes sense.”

Of the numerous underlying reasons for fibromyalgia, 10 factors are common:

Family history. About 50% of people with fibromyalgia have inherited gene variants that influence pain regulation.⁶
Infections. Lyme disease and other infections are known contributors.²
Emotional trauma. Chronic emotional stress may trigger fibromyalgia and subsequent flare-ups.⁵
Physical trauma. Head or neck injury or trauma to the upper cervical spine and spinal cord are also associated with increased risk.⁷
Immune health. Systemic inflammation and autoimmunity are two potential fibromyalgia culprits.⁸^,⁹
Mitochondrial dysfunction. Mitochondrial dysfunction, along with oxidative stress and nutrient deficiencies, can decrease antioxidant activity and increase reactive oxygen species, which may lead to fibromyalgia.¹⁰
Hormone imbalance. Fluctuating hormone levels, especially those associated with the hypothalamic–pituitary–adrenal (HPA) axis (which influences the stress response).¹¹
Sleep disorders. While poor sleep is a known symptom of fibromyalgia, sleep can also worsen fatigue and pain and may increase susceptibility to the condition.¹²^,¹³
Hypotension. Abnormally low pressure is associated with the onset of fibromyalgia pain.¹⁴
Diet. Poor nutrition, specifically a diet of highly inflammatory foods.¹⁵

Healthier habits for pain relief

Moderately paced exercise

One of the most important tools in managing fibromyalgia is gentle movement. Although exercise may seem intimidating with ever-present pain and fatigue, aerobic activity helps reduce stiffness and improve circulation. Walking, interval training, swimming, and stationary cycling can be especially helpful.¹⁶ The key is to start slowly and avoid pushing through pain. Even a few minutes a day can make a difference, as consistency matters more than intensity.

A steady sleep routine

Sleep quality and fibromyalgia symptoms are deeply connected.¹² Following a regular and calming bedtime routine can help signal to the body that it’s time to rest. Better sleep often has a ripple effect, easing other symptoms as well.

Managing day-to-day stress

Because fibromyalgia is closely linked to a sensitive nervous system, stress management is essential. Emotional stress, sensory overload, and even self-imposed pressure to “do more” can exacerbate symptoms. Deep breathing, meditation, journaling, gentle massage, and spending time in nature help calm the body’s stress response. Cognitive behavioral therapy, acceptance-based therapies, and somatic practices work on the nervous system’s processing of pain and stress.¹⁷

Eating well and staying hydrated

Although there is no single diet that works for everyone, many people feel better when they eat balanced, nourishing meals that support stable energy levels. Eating regularly, drinking enough water, and opting for whole foods may help reduce fatigue and inflammation.

Vitamins, minerals, and other supplements

Supplements may provide additional support for people with fibromyalgia, particularly vitamins and minerals that aid muscle relaxation, energy production, and sleep. Magnesium, melatonin, vitamin D, and vitamin B12 are commonly recommended, though responses vary.¹⁸ Because supplements can interact with medications, it’s important to consult a healthcare professional.

The SHINE protocol

Dr. Teitelbaum’s SHINE program (Sleep, Hormones/Hypotension, Immunity, Nutrition, and Exercise, as able) has helped many people manage fibromyalgia symptoms and reduce flare-ups. “Our randomized double-blind placebo-controlled study showed that the SHINE treatment plan resulted in 91% of people improving, with an average 90% positive increase in quality of life,” he notes.¹⁹ “Once the underlying factors are addressed, the key to eliminating flares is to optimize sleep, take a high-quality multivitamin, and reduce unnecessary stresses.”

Building a supportive network

Fibromyalgia is a widely misunderstood condition, and many people who live with the disorder feel unrecognized or dismissed. Connecting with supportive healthcare providers, friends or family members, and fibromyalgia support communities can reinforce that patients are not alone in their experience.

Footnotes

1
Kang J, Choi S, Park D, Lee S. Disentangling diagnosis and management of fibromyalgia. J Rheum Dis. 2022;29(1):4-13. https://www.jrd.or.kr/journal/view.html?doi=10.4078/jrd.2022.29.1.4
2
Bhargava J, Goldin J. Fibromyalgia. StatPearls. 2025;Jan 31. https://www.ncbi.nlm.nih.gov/books/NBK540974/?report=reader#_NBK540974_pubdet_
3
Fibromyalgia. Centers for Disease Control and Prevention. 2024;Jan 25. https://www.cdc.gov/chronic-disease/fibromyalgia/index.html
4
Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015;35:1115-1125. https://link.springer.com/article/10.1007/s00296-014-3208-7
5
Jafari M, Zadgari E, Amouzadeh-Lichahi M, et al. The global prevalence of depression and anxiety among fibromyalgia patients: a systematic review and meta-analysis. J Affect Disord. 2026;393. https://www.sciencedirect.com/science/article/abs/pii/S0165032725017823?via%3Dihub
6
D’Agnelli S, Arendt-Nielsen L, Gerra MC, et al. Fibromyalgia: genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers. Mol Pain. 2018;15. https://doi.org/10.1177/1744806918819944
7
Buskila D, Neumann L, Vaisberg G, et al. Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Arthritis Rheum. 1997;40(3):446-452. https://onlinelibrary.wiley.com/doi/10.1002/art.1780400310
8
Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129.https://doi.org/10.1016/j.neuroscience.2016.06.006
9
Paroli M, Gioia C, Accapezzato D, Caccavale R. Inflammation, autoimmunity, and infection in fibromyalgia: a narrative review. Int J Mol Sci. 2024;25(11). https://doi.org/10.3390/ijms25115922
10
Siracusa R, Di Paola R, Cuzzocrea S, Impellizzeri D. Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci. 2021;22(8).https://doi.org/10.3390/ijms22083891
11
Gupta A, Silman AJ. Psychological stress and fibromyalgia: a review of the evidence suggesting a neuroendocrine link. Arthritis Res Ther. 2004;6. https://link.springer.com/article/10.1186/ar1176
12
Fatima G, Das SK. Deciphering the role of sleep in fibromyalgia syndrome. J Sleep Med Disor. 2016;3(4). https://doi.org/10.47739/2379-0822/1055
13
Imamura M, Robertson C, Hudson J, et al. Effects of pharmacological and non-pharmacological interventions for the management of sleep problems in people with fibromyalgia: a multi-methods evidence synthesis. Health Technol Assess. 2025;29(20):1-228. https://doi.org/10.3310/GTBR7561
14
Bou-Holaigah I, Calkins H, Flynn JA, et al. Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia. Clin Exp Rheumatol. 1997;15(3). https://pure.johnshopkins.edu/en/publications/provocation-of-hypotension-and-pain-during-upright-tilt-table-tes-3
15
Soke N, Inceoz H, Solmaz I, Yardimci H. Proinflammatory diet is associated with higher pain, disease severity and biochemical parameters associated with inflammation in fibromyalgia. Pain Med. 2025;26(3):131-139. https://doi.org/10.1093/pm/pnae118
16
Rodríguez RB, Jurado-Castro JM. Aerobic exercise prescription for pain reduction in fibromyalgia: a systematic review and meta-analysis. Eur J Pain. 2025 Feb;29(2):e4783. https://doi.org/10.1002/ejp.4783
17
Roshan R, Tavoli A, Sedighimornani N, Goljani Z, Shariatpanahi S. Effects of relaxation and stress management training on fibromyalgia symptoms in women. Rheumat Res. 2017;2(4):119-126. https://doi.org/10.22631/rr.2017.69997.1030
18
Bjørklund G, Dadar M, Chirumbolo S, Aaseth J. Fibromyalgia and nutrition: therapeutic possibilities? Biomed Pharmacother. 2018 Jul;103:531-538. https://www.sciencedirect.com/science/article/abs/pii/S0753332218309697
19
Teitelbaum JE, Bird B, Greenfield RM, et al. Effective treatment of chronic fatigue syndrome and fibromyalgia—a randomized, double-blind, placebo-controlled, intent-to-treat study. J Chronic Fatigue Syndr. 2011;8(2):3-15. https://doi.org/10.1300/J092v08n02_02

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The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform health care in the United States by increasing public awareness of natural medicine and access to naturopathic doctors. Naturopathic medicine, with its person-centered principles and practices, has the potential to reverse the tide of chronic illness overwhelming healthcare systems and to empower people to achieve and maintain optimal lifelong health. INM strives to fulfil this mission through the following initiatives:

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Medically Reviewed By

Sarah Daglis, ND, MS

Sarah Daglis, ND, MS, is a naturopathic doctor, medical writer, and avid researcher. Driven by a vibrant enthusiasm for natural medicine, she is dedicated to educating others about the scientific evidence that supports the efficacy of alternative therapies and clinical nutrition in disease prevention and treatment. Rooted in a holistic approach to wellness, Dr. Daglis’s focus lies in the realms of cardiometabolic and digestive health.

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10 Root Causes of Fibromyalgia

Fibromyalgia symptoms and diagnosis

10 root causes of fibromyalgia