Can Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability?

Ross Hauser, MD, Caring Medical Florida

Myalgic encephalomyelitis (muscle pain from nerve inflammation) or Chronic Fatigue Syndrome is / are very complex disorders. It is difficult to determine their true causes as the true cause can be extremely multifactorial. There are numerous hypotheses as to cause and treatments.  If you are reading this article it is more than likely that you have been on a long medical journey and you are very well educated in the ideas of yeast, molds, environmental illness, diet, hormones, thyroids and adrenals, and a run away immune system that causes muscle pain. Sometimes this is diagnosed as Fibromyalgia.

You have been to many doctors, nutritional specialists, allergists, immunologists, endocrinologists and other specialists. You may have even traveled to a few gurus. While you may have been helped, you still struggle. For people like you, even the smallest help in finding answers to your challenges of excessive fatigue and the many symptoms that usually accompany chronic fatigue syndrome is met with hope, but guarded optimism.

Before we begin this article and research findings, if you would like to contact our medical team, please use our contact form page. We can help assess your candidacy for our treatments and answer your questions.

Can Chronic fatigue syndrome and Myalgic encephalomyelitis be caused by cervical stenosis and cervical spine instability?

In this article, we will present information and a case for cervical spine instability as a possible root cause of your health issues. It is not the grand unifying theory of Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS), but a concept of what may be happening in some patients.

We will show evidence that the pressure exerted by loose and floating vertebrae that pinch nerves and compresses arteries that pass through the cervical neck region may be an answer for you.

It is important to point out that not every sufferer of chronic fatigue syndrome will find that the origins of their problems are related to neck instability. The case we make is that some sufferers may. We are going to go straight to a research study to set the tone for this article that there may be a cervical neck connection to the onset and worsening conditions of chronic fatigue syndrome.

A cervical neck connection to the onset and worsening conditions of Chronic Fatigue Syndrome (ME/CFS)

While we practice regenerative medicine injection treatments to strengthen the cervical ligaments to bring stability to the neck, we are going to explore a surgical study from Johns Hopkins University School of Medicine. The point that we hope to show you is that if you treat cervical instability you may find relief from your chronic fatigue and muscle pain.

Writing in the Journal of Translational Medicine (1), the John Hopkins researchers described surgical outcomes for three patients here were their symptoms:

  • Cervical stenosis in all three
  • Positive Hoffman sign in 2 of 3 for twitching and spasmodic tendency
  • Tremor in 2 of the 3 patients
  • Absence of gag reflex in 1 of 3 signifying possible damage or compression of the vagus nerve
  • two patients had single- or two-level cervical spondylosis.

Two patients underwent Anterior cervical disc replacement surgery and the other a hybrid anterior cervical disc fusion and disc replacement in the third was associated with a marked improvement in myelopathic symptoms, resolution of lightheadedness and hemodynamic dysfunction (increased positive blood flow), improvement in activity levels, and improvement in global Myalgic encephalomyelitis or chronic fatigue syndrome.

Here is the conclusion of this case study from the surgeons:

“The prompt post-surgical restoration of more normal function suggests that cervical spine stenosis contributed to the pathogenesis of refractory ME/CFS and orthostatic symptoms. The improvements following surgery emphasize the importance of a careful search for myelopathic examination findings in those with ME/CFS, especially when individuals with severe impairment are not responding to treatment.”

Comment: Here a treatment (surgery) improved the conditions of chronic fatigue and muscle pain and the related symptoms of lightheadedness, symptoms associated with decreased blood flow, and energy output. This helped patients who had no help before. For those of you who want to explore a non-surgical option, we will explain below.

Why did these people respond so favorably? Alleviation of compression.

Are Vagus nerve inflammation and compression the cause of Chronic fatigue syndrome and Myalgic encephalomyelitis?

In this illustration compression at C1, C2, C3 can cause vagus nerve inflammation and contribute to the development of Chronic fatigue syndrome and Myalgic encephalomyelitis

In this illustration compression at C1, C2, C3 can cause vagus nerve inflammation and contribute to the development of Chronic fatigue syndrome and Myalgic encephalomyelitis

The Vagus nerve is part of a pair of nerves. You have the left side vagus nerve and the right side vagus nerve. Because the vagus nerves are so long, (vagus literally meaning wandering) they impact their a large number of bodily functions and systems. When the vagus nerve is compressed by vertebrates as in cervical stenosis,  it can cause disruption in the body systems and many problems for the sufferer.

In the above research, the surgeons pointed out that the patients suffered from tremors, twitching, spasmodic tendency, absence of gag reflex. As noted these symptoms seemingly point to a connection between vagus nerve compression and Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS).

Vagus nerve involvement in Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS) has presented some interesting research and speculation as to what may be the origin or etiology of their problem for so many people. At the onset of this article, we discussed that these disorders are very complex disorders. It is difficult to determine the cause as a cause can be very multifactorial. BUT, sometimes you can connect some dots that may lead some to a realization that it is cervical spine instability causing these health issues.

Common symptoms shared by cervical neck instability patients and Myalgic encephalomyelitis and Chronic Fatigue Syndrome patients

Cervical instability and craniocervical instability. Are common symptoms with Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

The person who comes to us for problems related to the cervical spine or craniocervical instability does not come in presenting one problem. They come in presenting many problems. We rarely get a patient who comes in with Myalgic encephalomyelitis or chronic fatigue syndrome as the primary concern. But fatigue is a dominating secondary concern. If you are reading this article you do not have to be convinced of the complexity of your case. We would, however, like to show more research that makes the case for cervical spine or craniocervical instability for symptoms related to patients with Myalgic encephalomyelitis or chronic fatigue syndrome.

This is a patient of ours, she explains her myriad of symptoms that included fatigue:

In the video, the patient, Katelin tells her story. Here is a summary of her video:

  • Katelin tells us that her life turned upside down quickly, three years prior to filming this video she developed a “slew,” of neurological issues within a span of three to four months. She went to her general practitioner, a neurologist, three or four physiotherapists, no one had any idea what was happening to her.
    • “I went from having something that felt like an ear infection to partial seizures.” Katelin’s symptoms included severe brain fog, tremors, episodes of partial blackouts, horrible fatigue, sleeping all the time, vertigo, and of being totally disabled.
  • At her visit with us from her home in Vancouver, we performed a digital motion x-ray which revealed cervical spine instability at C1 – C2. She had four initial treatments and was able to return to work within one year.

Cervical Vertigo and Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment? 87% Neck pain – 85% Fatigue seen in patients.

A 2013 study from Norwegian doctors published in the Scandinavian Journal of Pain (2) demonstrated that the patients in this study, with a primary diagnosis of chronic benign paroxysmal positional vertigo, that is dizziness with a change in head position, reported the following coexisting problems:

  • The majority of patients (87%) reported neck pain as a major symptom
  • Nearly as many reported Fatigue (85%) as a major symptom.
  • Nearly as many reported visual disturbances (84%) as a major symptom. Nystagmus included – repetitive, uncontrolled movements of the eyes.
  • Nearly as many reported decreased concentration ability (81%)

Visual disturbance, fatigue, and dizziness are well-known characteristics of patients with Myalgic encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS). So what is the origin of the problem?  Is ME/CFS the cause of these symptoms or is it cervical spine/neck instability? For a more detailed discussion see our article: Can neck problems cause vertigo? Cervical Vertigo and Cervicogenic Dizziness

Cervical Spine / Neck instability, vision problems, Myalgic encephalomyelitis, and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

At the onset of research into Chronic Fatigue Syndrome in the early 1990s (CFIDS – Chronic Fatigue Immune Dysfunction Syndrome) a connection between chronic fatigue and visual disturbances was immediately identified. In a 1992 study published in the journal Optometry and vision science (3) : the official publication of the American Academy of Optometry, researchers wrote that:

  • Chronic fatigue and immune dysfunction syndrome (CFIDS) is a disease presenting with systemic, sensory, cognitive, and psychological manifestations. Ocular symptomatology is reported in the visual, functional, perceptual, and pathological aspects of the visual system. It appears (based on our data) that the ocular symptoms of CFIDS are genuine.

In the 27 years since, there has been conflicting and confusing information in regard to using eye problems as a tool to verify Chronic Fatigue Syndrome or Myalgic encephalomyelitis. In 2000, researchers published a case-control masked study on 37 patients with Chronic Fatigue Syndrome to evaluate ocular signs, symptoms, and functional parameters. The research which appeared in the Annals of Ophthalmology (4) suggested “a significant association was between CFS and blurred vision at near (inability to make out fine details), foggy vision, shadowed vision, headaches, and photophobia (intolerance of light). Blurred vision, foggy vision, and headaches were associated with abnormal oculomotor function, and shadowed vision and photophobia were associated with tear deficiency.”

In their 2014 paper: “Characteristics of visual disturbances reported by subjects with neck pain,” Researchers at The University of Queensland wrote in the journal Manual Therapy (5) of the most difficult to treat and manage visual disturbances in their patients with neck pain.

  • The most prevalent symptoms that they found in the patients of the study were:
    • patient found that they had to concentrate to read‘ (70%) and
    • patient found that they had sensitivity to light‘ (58.6%).
  • Lesser prevalent but still impacting many patients were:
    • double vision (28.6%) and
    • dizzy reading‘ (38.6%).
  • The most troublesome symptoms were:
    • ‘need to concentrate to read (visual fatigue)
    • ‘difficulty judging distances’
    • and ‘sensitivity to light’ (photophobia)

The commonality is unavoidable. People who have these vision problems and a diagnosis of Chronic Fatigue Syndrome or Myalgic encephalomyelitis should be checked for cervical spine instability.

Cervical Spine / Neck instability – Headaches and Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

Many people with ME/CFS have headaches. These include classic migraine (aura) and accompanying visual disturbances to included flashes of lights and blackout areas in vision. Again, we want to point out that people with ME/CFS may have these problems as a result of their sensitivities to chemicals, environmental pollutants, and certain foods. We are not suggesting that migraine and headaches in ME/CFS have a singular cause in cervical spine neck instability. We are suggesting that it is a possibility in many.

In the medical journal, BMC Neurology (6) researchers at Georgetown University produced a detailed paper on migraines, headaches, and Chronic Fatigue Syndrome. This was part of the summation:

Chronic Fatigue Syndrome subjects have a high prevalence of migraine headaches that may be overlooked and undertreated. The proportion of an aura was similar to other migraine groups. CFS (sufferers with migraine and aura) was associated with higher severity scores for neural problems such as numbness and dizziness, and alterations of the heartbeat. The lower pressure-induced pain thresholds and hyperalgesia (high sensitivity to pain) found in the CFS subgroup (migraines without aura) was suggestive of nociceptive hyperresponsiveness (tissue damage causing breathing problems set off by asthma or exposure to an irritant) and central sensitization (Sensitivity to pain).”

In this short paragraph, we have two types of CFS sufferers. The later is the sufferer whose headaches and migraines were triggered by asthmatic or breathing problems. The former or first sufferer who has their migraines set off by events strongly linked to cervical neck instability.

In our 2014 research lead by Danielle R. Steilen-Matias, MMS, PA-C and published in The Open Orthopaedics Journal (7) our research team was able to demonstrate that when the neck ligaments are injured and cause cervical spine instability (excessive movement of the cervical vertebrae), in the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches.

A brief note on vertebrobasilar insufficiency. Typically this describes a narrowing of the arteries that is usually treated with blood thinners and cholesterol medication. In this context, vertebrobasilar insufficiency is describing a situation where hypermobility of the neck vertebrae is causing a “squeezing,” of the arteries by pinching movement. In the Georgetown research, it is worth noting again: “CFS (sufferers with migraine and aura) was associated with higher severity scores for neural problems such as numbness and dizziness, and alterations of heartbeat.”

Please refer to our article Vertebrobasilar insufficiency – Hunter Bow Syndrome – Cervical neck instability for more on this possible connection to problems in ME/CFS.

Laryngeal Manifestations – voice and airway dysfunctions, Myalgic encephalomyelitis and Chronic Fatigue Syndrome, is this a clue to cervical instability being the problem and a road to proper treatment?

Here is an April 2020 (8) study published in the Journal of the American Medical Association (JAMA) otolaryngology, head & neck surgery from researchers at Johns Hopkins University.

  • Fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome are traditionally considered as distinct entities grouped under chronic pain syndrome of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology. (Our note: they all have something in common that has not yet been fully understood).
  • All three of these disorders may share symptoms of voice and laryngeal disorders. This study sought to make a determination of the prevalence of voice and airway path dysfunction with Fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome.


  • Conclusions and relevance: The voice and airway presentation of patients with Fibromyalgia syndrome, irritable bowel syndrome, and/or chronic fatigue syndrome appear to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.

My note: What could be a shared cause? Upper cervical instability

Research on cervical instability non-surgical treatments

Caring Medical Regenerative Medicine Clinics has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problems described in this article which may impact the Myalgic encephalomyelitis and Chronic Fatigue Syndrome diagnosed sufferer.

In this video, a demonstration of treatment is given

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD is giving the injections.

In our 2014 study mentioned earlier in this article, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments.

This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems are not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”

What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and possibly in the case of Myalgic encephalomyelitis and Chronic Fatigue Syndrome type symptoms, cervical instability. (7)

Prolotherapy, the curve of the neck and blood flow

In this image, the progression and degeneration of the cervical spine is demonstrated, from Lordotic curve to the Military curve to the Kyphotic curve to the "S" curve of severe osteoarthritis.

In this image, the progression and degeneration of the cervical spine is demonstrated, from Lordotic curve to the Military curve to the Kyphotic curve to the “S” curve of severe osteoarthritis.

In February 2016 a paper appeared in the Medical Science Monitor: international medical journal of experimental and clinical research.(8) Here medical university researchers in Turkey made these observations:

  • “The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. (Reduced blood flow into the brain).”
  • “(Our) study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity.”

This is research with which we have seen empirical evidence of in our over 27 years of regenerative medicine practice. To fix the problems related to the cervical spine, you need to restore the natural curvature of the neck. This is part of our Caring Cervical Realignment Therapy (CCRT) developed by Ross Hauser, M.D. This program was the evolutionary product of decades of treating patients with neck disorders, including cervical instability and degenerative disc disease, to provide long-term solutions to cervical neck instability related symptoms. CCRT combines individualized protocols to objectively document spinal instability, strengthen weakened ligament tissue that connects vertebrae, and re-establish normal biomechanics and encourage the restoration of lordosis.

Research: Correct the problems of loss of lordosis: immediately increase cerebral blood flow

In the medical journal Brain circulation (Jan-March 2019) (9), doctors wrote of their analysis of case study patients who had  cervical lordosis. They wrote that if you restored the natural curve to the neck, you could immediately increase cerebral blood flow as pressure is removed from the cerebral artery.

Here are the learning points of this research. They present a good summary of what we discussed in this article:

  • Loss of lordosis of the cervical spine is associated with decreased vertebral artery hemodynamics (blood flow).
  • Based on the close anatomical relationship between the cervical spine, the vertebral arteries, and cerebral vasculature, the researchers speculated that improvement in cervical hypolordosis increases collateral (from the side) cerebral artery hemodynamics and circulation.

The challenges of Vertebrobasilar insufficiency are many. Fixing cervical neck instability is not something can be treated simply or easily, it takes a comprehensive non-surgical program to get the patient’s instability stabilized and the symptoms abated. We believe that if you have been going from clinician to clinician, practitioner to practitioner, doctor to doctor, there is a good likelihood that you have problems of cervical neck instability coming from weakness and damage to the cervical ligaments. Our treatments of dextrose Prolotherapy and in some cases Platelet Rich Plasma Prolotherapy can be an answer.

If this article has helped you understand the problems you are facing and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists

1 Rowe PC, Marden CL, Heinlein S, Edwards CC. Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis. Journal of translational medicine. 2018 Dec;16(1):21. [Google Scholar]
2 Iglebekk W, Tjell C, Borenstein P. Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV). Scandinavian journal of pain. 2013 Oct 1;4(4):233-40. [Google Scholar]
3 Potaznick WA, Kozol NE. Ocular manifestations of chronic fatigue and immune dysfunction syndrome. Optometry and vision science: official publication of the American Academy of Optometry. 1992 Oct;69(10):811-4. [Google Scholar]
4 Mastropasqua L, Ciancaglini M, Carpineto P, Iezzi A, Racciatti D, Falconio G, Zuppardi E, Pizzigallo E. Ocular manifestations in chronic fatigue syndrome. Annals of ophthalmology. 2000 Sep 1;32(3):219-24. [Google Scholar]
5 Treleaven J, Takasaki H. Characteristics of visual disturbances reported by subjects with neck pain. Manual therapy. 2014 Jun 1;19(3):203-7. [Google Scholar]
6 Ravindran MK, Zheng Y, Timbol C, Merck SJ, Baraniuk JN. Migraine headaches in chronic fatigue syndrome (CFS): comparison of two prospective cross-sectional studies. BMC neurology. 2011 Dec;11(1):30. [Google Scholar]
7 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
8 Piersiala K, Akst LM, Hillel AT, Best SR. Chronic Pain Syndromes and Their Laryngeal Manifestations [published online ahead of print, 2020 Apr 30]. JAMA Otolaryngol Head Neck Surg. 2020;e200530. doi:10.1001/jamaoto.2020.0530
9. Katz EA, Katz SB, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD. Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation. 2019 Jan 1;5(1):19. [Google Scholar]


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