Triggers for fibromyalgia

Managing fibromyalgia can feel unpredictable one day your symptoms are completely manageable, and the next you're dealing with increased pain, fatigue, the so-called fibro fog, or insomnia seemingly out of nowhere.

Understanding which factors tend to coincide with your flares can help you better manage symptoms and improve your quality of life.

Common Fibromyalgia Triggers to Look Out For

Everyone's fibromyalgia experience is unique, and what affects one person may not affect another. But there are common factors that tend to influence symptoms, says Mary Ann Fitzcharles, MD, an associate professor of medicine in the division of rheumatology at McGill University in Montreal, who treats people with fibromyalgia.

We refer to what is the initiating factor. [They] tend to be present when symptoms are aggravated or heightened, Dr. Fitzcharles says.

1. Weather Changes

Many people with fibromyalgia report worsening pain and stiffness during changes in temperature or barometric (atmospheric) pressure. "Patients will say, 'I can forecast the weather much better than the weatherman,'" Fitzcharles says.

2. Cold Temperatures

Seasonal transitions, such as the transitions into spring and fall, can also be challenging because temperatures fluctuate more frequently between warm and cool, Fitzcharles says.

3. Strong Scents, Bright Lights, and Loud Noises

This hypervigilance manifests by people saying, I just don't like it when I'm in a room with lots of noise. Or when the children are making a lot of noise or when the TV is too loud, it disturbs me, she says.

4. Poor Sleep

5. Physical Overexertion

6. Diet

Research on diet and fibromyalgia is emerging and mixed, and theres no science-backed fibromyalgia diet proven to work for everyone, Fitzcharles says. Instead, some people might notice certain foods seem to worsen their symptoms, she says.

7. Hormonal Fluctuations

8. Illness and Infection

9. Stress

Track Your Fibromyalgia Triggers

These tools can help doctors measure pain, fatigue, sleep disturbances, and other symptoms, but they can also help people with fibromyalgia recognize improvements that they may not have noticed, he says.

Lenz recommends keeping a journal to track patterns that may be associated with symptom changes. Consider writing down your:

• Sleep quality and duration
• Stress levels
• Physical activity
• Weather changes
• Menstrual cycle changes, if applicable
• Dietary habits
• Symptom severity

Tracking should be viewed as a tool to identify connections or patterns, but not a diagnosis, Lenz says.

Many people with fibromyalgia already have a good sense of the factors that tend to worsen their symptoms, Lenz says. Most people don't have to catalog and say, I don't know which one it is. They know if they can't handle cold weather, or if too much noise going to a busy social gathering might be an issue, he says.

Fitzcharles suggests flipping the question around when tracking, too. Instead of only focusing on what may have contributed to a flare, she encourages patients to pay attention to what happens on days when they feel better.

"What made it such a good day?" she says. "Can you identify the factors that really gave you a better day rather than what made it bad?" Maybe it was sunny, you were out gardening, or you had a good nights rest.

Looking for the habits, routines, and circumstances that support your well-being may be just as valuable as searching for factors that worsen symptoms.

And, at times, there may not be any rhyme or reason for symptoms, Fitzcharles says. It's not unusual that patients will say they have a few good days and then out of the blue, they have a bad day. And they just can't attribute it to anything, she says.

How to Avoid Your Triggers

While it may not be possible to prevent every flare, focusing on habits that support your overall health can help. They include:

• Prioritize sleep. Sleep issues are one of the strongest triggers of fibromyalgia symptoms. It can help to practice good sleep hygiene (healthy habits that help you sleep), such as aiming for a consistent bedtime and wake time, unplugging from screens an hour before bedtime, and utilizing blackout curtains to keep bright light from entering your bedroom while youre sleeping.Research suggests good sleep hygiene is effective for improving sleep quality and relieving pain in people with fibromyalgia.
• Pace yourself. Many people with fibromyalgia experience what experts call a "boom-and-bust" cycle, Lenz says. Feeling better may lead to overdoing activities, which is then followed by days of increased symptoms, like pain, soreness, and muscle aches.Instead, try spreading activities evenly throughout the week and proactively building in recovery time before you feel exhausted.
• Stay active. Exercise doesn't have to mean intense gym sessions, Fitzcharles says. Walking, gardening, household chores, swimming, or playing with children or grandchildren all count as meaningful physical activity. "It might just be going for a good 20-minute walk, she says.
• Manage sensory overload. If you notice that noise, clutter, bright lights, or strong scents make symptoms worse, creating a calmer environment may help reduce stress on your nervous system.
• Do your best to manage stress. If youre facing prolonged stress, speak to your doctor, who may refer you to mental health support, such as cognitive behavioral therapy.

The Takeaway