Management Basics
Focus on preventing PEM and relieving symptoms with shared decision-making; start low, go slow.
Pacing & PEM Prevention
Core strategy: activities should not provoke Post-Exertional Malaise.
- Pacing/energy-envelope education; activity should not provoke PEM.
- Provide written pacing guidance and crash plan.
Crash plan
- Early rest at first warning signs; avoid “pushing through”.
- Reduce upright time and cognitive load; prioritize recovery.
- Reassess triggers; adjust envelope before resuming baseline.
Sleep Optimization
Aim for restorative sleep before stimulants or sedatives.
- Sleep hygiene; consider melatonin or low-dose agents for restorative sleep.
Pain & Headache
Multimodal approach; treat migraine where present.
- Multimodal pain/headache approach; treat migraine where present.
Medications & Supplements
“Start low, go slow.” Pair med changes with pacing to avoid PEM.
Medications
- OI: fluids/salt/compression ± medications per judgment and comorbidities.
- Consider low-dose naltrexone (LDN) for pain/fatigue modulation.
Supplements / Deficiencies
- Correct deficiencies (vitamin D, B12, iron/ferritin).
Follow-Up & Safety
Reassess regularly; avoid abrupt multi-drug changes.
- Review PEM frequency/severity and orthostatic symptoms every 4–6 weeks.
- Adjust one variable at a time; document response and crashes.
- Coordinate accommodations (reduced upright time, remote options, rest breaks).
For health professionals. Informational only — not medical advice. Based on IOM/NAM 2015 criteria and common clinical practices.
