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Brain Fog Basics – Managing the Cognitive Dysfunction of Fibromyalgia (and ME/CFS)

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Managing Fibrofog - The Cognitive Dysfunction of Fibromyalgia

Dr. Pellegrino has seen more than 20,000 FM patients in his practice at Ohio Pain & Rehab Specialists, and is a fibromyalgia patient himself. This information is reproduced with his kind permission.*

Managing Fibrofog - The Cognitive Dysfunction of FibromyalgiaPerhaps the most frustrating complaint I hear from patients with Fibromyalgia is the brain fog, or ‘fibrofog’.

Unlike the pain and fatigue which are usually constant nuisances, this problem causes unpredictable difficulties with our thinking. The unpredictability is the very reason it’s most frustrating. You never know when it will strike.

Fibrofog… is the cognitive dysfunction brought on by Fibromyalgia (or ME/CFS).

Its symptoms include:
• Forgetfulness
• Absentmindedness
• Concentration problems
• Confusion
• Disorientation (get lost easily)
• Difficulty finding or saying words
• Short-term memory loss
• Difficulty understanding what you’ve read
• Difficulty calculating simple math problems
• Mixing up words
• Right-left confusion
• Poor ability to give directions.

Additional cognitive symptoms with more emotional components include:
• Depression
• Irritability
• Anxiety
• Panic attacks.

Fibrofog is not a dementia or early Alzheimer’s.

We demonstrate normal learning and memory although we process information more slowly because of our Fibromyalgia.


Multiple factors are probably involved in causing symptoms of fibrofog.

On a hormonal level, we have lower than normal concentrations of serotonin and norepinephrine in our brains. Serotonin is important for controlling pain in our central nervous system and relaxing our brain. Norepinephrine is responsible for focusing our thoughts and helping us concentrate. A low level of these 2 hormones will increase fibrofog symptoms.

Our brain’s attention centers are overwhelmed with signals which may contribute to neurological causes of fibrofog. At the attention centers, sensory signals arrive and are relayed to different areas including centers for emotion, motor reactions, and memory.

If the attention and relay centers are continuously bombarded by pain signals, the centers may be “overwhelmed” and signals get processed more slowly or blocked, or even lost altogether. This can result in symptoms such as word-finding difficulties, inability to remember something, or delayed recall.

Pain and fatigue demand attention from our brain. Our brains continuously monitor these extra “doses” of symptoms in Fibromyalgia. This engages so much of our brain’s attention that very little attention “space” is available to allow us to process, retain and recall “routine” information.

Analogy: The Cluttered Hallway

In order to explain fibrofog to my patients, I have come up with the “cluttered hallway” analogy. Picture your brain as the upstairs of a house. In this house, the upstairs bedrooms are neat, organized, and behind closed doors. The common hallway leading to each bedroom is cluttered with laundry baskets, piles of clothing, boxes, shoes, toys, and furniture. One has to navigate the clutter in order to access a bedroom, causing some delay in reaching the door.

The person trying to get into the bedroom is like the nerve signal trying to access a memory trace.

• The person (nerve signal) climbs the steps (spinal cord) up to the second floor (brain) and is standing in the common hallway (attention center).

• The egress to the bedroom door (memory) is slowed by all the clutter (neurochemical changes from Fibromyalgia). Sometimes it seems to take forever to get to a door, and at other times the person can’t remove all the clutter to open the door in a timely manner. This leads to either delayed processing or inability to read the intended thought or memory.

• Once one gets to the bedroom door and opens it, the room (memory) is in good order and can be accessed freely. In Fibromyalgia, the bedrooms are neat. In dementia, the bedrooms would be in a disarray.

The bottom line is: Keep your bedroom clean and let’s work together on clearing the hallway.

Another Analogy: Cable Access vs. Dial-Up

To those of you who are computer literate, a simple fibrofog analogy is like having dial-up Internet service on your computer instead of cable access.

If you have Internet service through your phone line, you often experience nuisance delays, or even get “kicked off” before you can get online. Once online, the computer’s memory and web pages are in order, but you may experience long delays to access them. Sometimes the delays are so long that you get “timed out.” Signals trying to get through the phone line to retrieve web pages are like signals trying to get through our attention center to retrieve memories.

Why don’t normal people without Fibromyalgia have these delays? Because they have cable connections for their computer and their signals travel quickly without delay.

Doctors with Fibromyalgia who try to write about fibrofog analogies often make things more complicated and confuse themselves in the midst of their writing… Or whatever it was they were trying to do.


There are a number of strategies to try to treat fibrofog. We can try to take advantage of every strategy available to keep our minds less befuddled.

Write Things Down

Write notes frequently and organize the notes. When I write material for my books I go through a routine where I jot down ideas and notes on pieces of paper and collect these papers. Then I start to organize these notes in an outline format. I think of details and let my thought processes evolve over days and weeks, while continuing to write notes and organize these notes. From there on I can write my first version of the chapter, revising and categorizing along the way.

If one writes down notes and plans his or her days, or writes down names of people met or key pieces of information for an upcoming meeting or visit, the writing preparation serves two purposes.

First, the writing actually reinforces what you are trying to remember. When you write something down you are delivering information via a different pathway to the brain and make it easier to remember by just “thinking it.”

Second, when you write something down, you can allow your mind to relax and not worry about forgetting it, because you can simply refer to your written notes.

Consistent Routine

You need to consciously train yourself to follow a routine and strive for consistency. I always try to follow a specific routine. For example, my car keys can only be in three places: my pocket, on top of my desk, or on the kitchen counter. When I come home from work, I’ve trained myself to put them in those places. If I throw the keys on the bed, for example, I must consciously tell myself to stop everything and take the keys to the proper location.

I used to think “I’ll remember where they are,” but a few seconds later that memory was completely gone and later on I would spend many minutes searching for my keys.

You can train yourself to follow a consistent routine with practically everything you do, from the time you go to bed to the time you get up:

• The order in which you approach your morning routine;

• The locations where you’ve placed all your necessary items;

• The day planner that you check off as you complete different tasks, and so forth.

Once you have trained yourself, it will become automatic for you. Plus, the routine will save you a lot of time and frustration. In this case the best desired strategy is “same-old, same-old.”


Because we have difficulty with our attention spans and our ability to recall information, we are more prone to increased mental stress – which further contributes to mental fatigue.

Achieving a relaxation response helps to counteract episodes of fibrofog. So practice your relaxation strategies that you’ve learned. Make this routine part of your day. Many times we think our best thoughts and remember the most when we are relaxing, lying down, and trying to get to sleep.


A number of prescribed medicines can be considered to help counteract the symptoms of fibrofog.

• Selective serotonin reuptake inhibitors (e.g., Prozac, Zoloft, Lexapro, Paxil) can work by helping to increase the serotonin level in the brain and facilitate neurobiological connections between the attention center and other brain centers.

• Medicines that include norepinephrine (Wellbutrin, for example) can help as well.

• Medicines in the central nervous system category (e.g., Cylert, Ritalin, Provigil) may also help by improving our brain alertness and attention. Any medicine strategy that helps reduce pain and improve energy level can help the fibrofog by reducing all the overwhelming signals that bombard the attention center and clutter the hallways.

Prescribed medicines can also interfere with memory, so they need to be evaluated and adjusted if they are aggravating fibrofog.

Examples of medicine categories that can affect memory include selective serotonin reuptake inhibitors, tricyclic antidepressants, muscle relaxants, beta blockers, anti-anxiety medicines, anti-seizure medicines, and other medicines that have been used in the treatment of Fibromyalgia.

Any medicine that causes sedation or fatigue has potential to aggravate Fibromyalgia as well.


Some of the supplements that can be used to try to improve fibrofog include 5-HTP, colostrum, ginkgo biloba, and vinpocetine.

• The 5-HTP works by providing a substrate for the body to build more serotonin. [5-HTP (5-hydroxytryptophan) is a natural amino acid that represents the intermediate step between tryptophan and the important brain neurotransmitter serotonin. It is often low in FM (and ME/CFS) patients.]

Colostrum [as in Transfer Factor] works by increasing growth hormone level, which enhances brain activity.

• Another supplement that can improve fatigue and fibrofog is ginkgo biloba. This supplement is thought to work by enhancing short and long-term memory by improving recall and retention, improving systemic blood flow, and facilitating nerve signals. A pilot study published in 2002 found that 64% reported improvement when taking a combination of ginkgo biloba and Coenzyme Q10 (CoQ10) for Fibromyalgia.(1)

Vinpocetine (derived from periwinkle leaves) is a specific supplement that is felt to improve blood flow to the brain. Increased brain blood flow can boost glucose and oxygen use, and improve fibrofog symptoms; dosing is 10 to 30 mg a day.(2)

Don’t Be Too Hard on Yourself

We try to do the best we can with forgetfulness and fibrofog symptoms. Some people can do well with memory association tricks such as trying to associate a person’s name with a familiar object.

I think the most reliable way is to:

• Write things down,

• And know where to look for this written information.

You reinforce the memory by writing it down, and you can relax your mind better because you know where to look for this information when you need it. You give yourself “permission” to forget.

* * * *

Even though we may strive for a routine and may be successful at it, we will still forget things. We should not get mad at ourselves when this happens, and try to simply work around what we’re forgetting. Simply recognize that fibrofog is part of your Fibromyalgia and if you forget something it’s really not your fault.

* This article is excerpted with kind permission from Dr. Pellegrino’s highly regarded book Fibromyalgia: Up Close & Personal, © Anadem Publishing, Inc. and Mark Pellegrino, MD, 2005, all rights reserved. Copies of the book may be ordered from Dr. Pellegrino’s office at the Ohio Pain & Rehab Specialists Center; phone 330-498-9865; toll-free 800-529-7500.

1. “An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with ginkgo biloba extract in Fibromyalgia syndrome,” Journal of International Medical Research, Mar 2002.

2. See for example, “Effects of Vinpocetine on mitochrondrial function and neuroprotection in primary cortical neurons,” Neurochemistry International, Dec 2008.

Note: This information has not been reviewed by the FDA. It is generic and is not intended to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.


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14 thoughts on “Brain Fog Basics – Managing the Cognitive Dysfunction of Fibromyalgia (and ME/CFS)”

  1. Artilla says:

    Thank you! This is the best written article, for explaining how Fibromyalgia works, that I have ever read.

    Thank you for being more concise, the use of less medical terminology, to describe things. This is something I could share with friends who don’t understand, but, who want to.

    It’s also something that a person with Fibromyalgia can actually slog through and understand, when they are too tired for all those other articles.

    Yaye for you!

  2. MSBNURSE1 says:

    After much personal research and being a research nurse as an occucpation, I have embarked on a personal theory for all the Fog/FMS DX….instead of it being called Fibromyalgia…I believe the correct name should be
    “Thyro-myalgia or hypothalmic-myalgia”. In theory,
    ” most” of the patients who have this apppear to be women, usually 30 y/o and over, who are at a time in life when beginnings of undue stress causes depleting hormones (unknown to them since most Dr.s chose NOT to get involved in chkg them early on..perhaps it may improve ones health? and lessen their office visits??) In any case, after much of my own research and later a return to health, I found a nurse practioner who helped me immensely with knowledge and suggestions, to discover the downward spiral of what happens when hormones get out of whack due to hypothalmic dysfunctions that begin to occur in our early 30’s and that only further deplete themselves with stress and of course AGE! I am not surprised..it all makes clear sense.So why then are most Male and some female Dr.s so unwilling to attend informational seminars and learn the NEWER versions of female medicine,because treating men and women with the same attitude and treatments is not even close in effectiveness! Instead of signing in and staying at a CME to learn, most will leave to go golfing/shopping… instead of listening..yes I have been there and witnessed it MYSELF many times and they ARE NEVER monitored for their attendance at CME/CEU activities as nurses are but still receive their CME hours for “learning”)

    I’ve seen and personally experienced a revolutionary way of treating FMS/CFS, and it’s simply by beginning with testing all the endocrine hormones, testing for sleep apnea and then by keeping all hormone levels in “balance” via appropriate medications (and sometimes supplements) for each system. One can then be able to start to throw away those pain meds and ever so prominently RX’d depression meds ( dispensed like candy for whiny female patients at the drop of a hat by their tired/stressed Dr.s to eliminate female compalints and “mellow them out”!) Come on Dr.s, get with it and realize that women have a valid complaint once hormones that help keep us going..get depleted..(and then because no one has enough guts to step out of the “box” to go with newer TX modalities) and then seriously depleted to the point we lack energy/drive/emotions and worse,add to the mixture weight gain and cognition abilitites and feeling physically ill.. ( ALL which are directly related to decreasing hormone levels as seen in medical journals every where.) After hormone levels drop so seriously, we then acquire pain all over our bodies. Would it not be easier to nip this in the bud before we start all the meds and patient labeling?? Is it not possible that osteoporosis could be a preventable issue if we would just do ANNUAL monitoring of the levels of Vitamin D25 Hydroxy, Cortisol, DHEA SULFATE, ESTRADIOL, PROGESTERONE,FREE T3, FREE T4,TSH AND TOTAL TESTOSTERONE LEVELS at each visit we have for our annual PAP smear and breast exam? If this were the “Standard of Practice” world wide, instead of kept behind closed doors for fear of making people healthier and decreasing your income…the world would be a better place for us all. I am on tx for my thyroid with Synthroid (generics, even though the price is “right” did not work for me, which is often the case in some people.) I also take Bio-ID Hormone tx,and I no longer require the long list of meds for each symptom I had when I was active with FMS symptoms. I have cut out refined carbs/sugar and flour and am on my way to a much healthier life style and have lost 40 pounds over 2 yrs. I am age 57 and have battled this disorder for 18 yrs and have finally rid my body of most of those hard core drugs that were prescribed with each new complaint I had ( it usually added yet another side effect and another drug for that!)It saddens me to think my fellow medical professional failed so miserably and may possibly have been hiding treatment from patients for this disorder, due to their own inability/or choices to learn about new treatments of FMS/CFS and a host of other female related illnesses! It is easy to look this info up on the internet..and easier yet when you have physically participated in the healing of YOUR own body with new treatment protocols,if only Dr.s would make it available to their patients by learning it themselves!!
    This practice of the newer treatment for FMS/CFS all makes so much sense to anyone who has a medical mind that it is a crying shame that the Dr.s of today prefer to practice only what they know..from 20 yrs ago when they went to medical school and not to acknowledge/try newer and BETTER TXs for today’s diseases, especially in womens medicine!

    Just had to comment..due to my own ill-suffering for 18 yrs and most recent healing from the “added stress/depleting hormone disease called “FMS/CFS”….you too could be better..if your Dr. was better informed and more open minded to new disease protocols available in the medical communities today.

    “Let us not line the pockets of those who keep us from knowing true wellness, by insisting on using old medicinal treatments.. due to their own ignorance.”

    1. fnx3 says:

      You got the whole LOT – exactly my own feelings as per my own 18 year battle with symptoms that were finally labeled Fibromyalgia – that it was “the Hormones, Dummy!” – yet no doctors would ever test me for them but just destroyed my health even further by saying that I had an unknown mental illness & then trying me on about 16 different psych medications until I just told them all to “f…. off”!

      Great to read – THANK YOU!:)

      And I still don’t know how to get personalized treatment for hormone imbalance & so continue to struggle with the symptoms 🙁

    2. fnx3 says:

      Gosh this doc seems to really understand – that the source of the whole FMS mess is in the brain signals.

      And that it is these messed up signals that cause the hypothalamus & pituitary gland to mess up the hormone delivery that messes up the adrenal & thyroid glands & DOWN WE GO in the vicious dwindling spiral that is Fibromyalgia!!!

      BUT no-one knows how to find & fix that place in the brain that is causing the faulty signalling – I think it is the Brain Stem but still haven’t found any research that can fix it.

    3. fnx3 says:

      You got the whole LOT – exactly my own feelings as per my own 18 year battle with symptoms that were finally labeled Fibromyalgia – that it was “the Hormones, Dummy!” – yet no doctors would ever test me for them but just destroyed my health even further by saying that I had an unknown mental illness & then trying me on about 16 different psych medications until I just told them all to “f…. off”!

      Great to read – THANK YOU MSBNurse!:)

      And I still don’t know how to get personalized treatment for hormone imbalance & so continue to struggle with the symptoms 🙁

    4. kateinmo says:

      Thanks for the confirmtion!

      I had a complete psych eval two years ago because I feared I was getting Alzheimer’s–my mom and three of her sisters had it.

      Results: I don’t have dementia or Alzheimer’s, just fibro fog, some anxiety, and some stress. Their suggestions: 1) maintain a structured and scheduled daily routine; 2) use a notebook/planner to maintain all information; 3) when I am fatigued, in pain or stressed, modify my activities accordingly.

      I’ve worked very hard to do the above. I carry a small purse calendar and a 4 x 6 spiral bound notebook in my purse. When I get home, I tranfer any new information to my desk-sized calendar and my 8 1/2 x 11 spiral bound desk notebook. I cross off events and tasks as they are finished. In the notebooks, when a page has all tasks crossed off, I tear it out and toss it. What a sense of accomplishment!

      My husband has worked with me tirelessly to help me train myself to put things in the same place every time. I’m getting better at it, thus lessening my anxiety and stress.

      I structure my week around the Monday, Wednesday and Friday one-hour Arthritis Foundation Exercise Program that I teach. The exercise helps keep me scheduled. In each class, I include an exercise that exercises our brains as well as our bodies. I call them ‘twofers’.

      I finally realize that I absolutely must pay attention to my fatigue, pain and stress levels and adjust my activities accordingly. I’m much better at saying, “No, I can’t help you with that activity now, but ask me again.” And I’m much better at just saying no. Such freedom!

      Wishing you all success in making the changes Dr. Pellegrino suggests. They work!


    5. soffy says:


    6. ironspine says:

      You must Read THIS!!!!
      My son has had ADHD, anxiety, and depression. He is clumsy and always tired. He has had trouble with comprehension.
      I have also had fibro for 8 years, getting gradually worse.
      We heard about a chiropractic neurologist in our area, so we decided to see him.
      This doctor gave my son an EEG; had him do hand/body eye coordination tests; had him run up and down the hall to determine balance. From these tests our son was diagnosed with FDS, or Functional Disconnection Syndrome. It is a disruption in the brain and nervous system, causing neurogical disfunction. This produces: CHRONIC PAIN, BRAIN FOG, LEARNING AND SPEAKING DIFFICULTIES, DIZZINESS AND DEPRESSION, among other common problems.
      Traditionally these are all treated with drugs to mask the symptoms. This doesn’t help the CAUSE.
      The EEG determined that my son has 2 areas of the brain that are not working together.
      There are methods of natural treatment that can facilitate the repair of this problem.
      We are now having our son undergo chiropractic treatment with gentle adjustments first, for 3 weeks. Then our son is to do coordination exercises designed to stimulate the areas of the brain that need to work. This is all computerized and we can see daily the improvement!
      Our son has been on Risperdal and antidepressants, and we’ve already cut down on these.
      Look up this type of treatment on the internet-our doctor’s site is http://www.drkurtkuhn.com
      Doesn’t it make sense?????

    7. pain_man says:

      MSBNURSE1 made some good points but I would like to add that FM affects men too. Please realise that FMS is not just a women’s problem and that other factors may be involved, in both men and women, than you describe here.

    8. Lyme says:

      This sounds just like lyme fog to me. I would get checked for lyme disease if I had these symptoms again. I was cured with 1.5 years of IV antibiotics. The IDSA guidelines are used by HMOs and insurance companies to abandon patients to the disease.

  3. CeeQueue says:

    at the car keys analogy. Those are the exact same places I leave my keys, and if I put them anywhere else and think I’ll remember, I also always forget. It’s the same with anything I think I’ll remember. It could be 5 seconds later (no exaggeration) and I’ve already forgotten what I was trying to remember.

    I also agree wholeheartedly with the advice to write things down and how just the act of doing so reinforces the memory. It gives your brain two different ways of finding that bit of information.

    Thanks for the great article.

  4. nightbloomingcereus says:

    Good explanation of what my husband experiences frequently although he doesn’t have Fibromyalgia or ME/CFS. However, actual clutter increases his confusion and irritability. We have just moved to a new home and he “hit the wall” yesterday and is frustrated. Unfortunately, he is too hard on himself which only increases the irritability and sense of being overwhelmed.

    Both of us have found that Acetyl-L-Carnitine helps reduce brain fog and increases energy and focus immensely. Serrapeptase reduces inflammation and body aches greatly. Perhaps I can get him to try some of the supplements Dr Pellegrino mentioned in this article.

  5. ladymae says:

    Thank you so much for this well explained article. I had just had a nueropsych evaluation made due to this very thing. Within the last 6 months I have lost two jobs because of my memory. I have never lost a job in 43 years of working. What a devastating and ego deflater situation!

  6. ccantiques says:

    I very surprised you didn’t mention NADH as an important supplement to clear brain fog. It is the MOST important supplement I use to clear up brain fog, I call it my “smart pill”. I’ve been taking it for years and can’t think without it. I just finished graduate school and could never have done it without large doses of NADH.

    By the way, I take large doses of CoEnzyme Q10 and have for many years (I’ve been ill for 22 years). It does nothing for brain fog, but its very effective for cardiac arrythmias.

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