Causes and Triggers

3–4 minutes

Two separate questions tend to get tangled when people talk about fibromyalgia: what causes the condition to develop in the first place, and what triggers symptom flares once someone has it. The answers are different, and the distinction matters for managing daily life.

Medical science does not yet know the exact root cause of fibromyalgia. Research has, however, identified a number of factors that appear to contribute.

What causes fibromyalgia to develop?

Fibromyalgia is increasingly understood as a condition of central pain processing — a change in how the brain and spinal cord interpret and amplify pain signals. Why this develops in some people and not others is still being researched.

Several factors appear to contribute, often in combination:

  • Genetic predisposition. Fibromyalgia tends to run in families. Research suggests certain genetic variations may affect how the nervous system processes pain, making some people more vulnerable to developing the condition.
  • Physical trauma. A serious accident, injury, or major surgery can trigger fibromyalgia, particularly when recovery is prolonged or painful. Whiplash and spinal injuries have been specifically studied as potential triggers.
  • Infection. Some viral and bacterial infections appear to act as triggers. Epstein-Barr virus, influenza, Lyme disease, and more recently COVID-19 have all been linked to fibromyalgia onset in some people.
  • Prolonged stress and trauma. Extended periods of severe physical or emotional stress — including bereavement, long-term caregiving, or exposure to traumatic events — are associated with a higher risk of developing fibromyalgia.
  • Other chronic conditions. Fibromyalgia sometimes develops alongside conditions such as rheumatoid arthritis, lupus, or ankylosing spondylitis.

A note on the stress link The association with stress and trauma is sometimes misinterpreted as evidence that fibromyalgia is a psychological condition. It is not. The physical changes in pain processing are real and measurable. Stress appears to be one of several factors that can trigger those changes in someone already predisposed — not a cause of imagined symptoms.

What triggers a flare?

Once fibromyalgia is present, symptoms tend to come in waves rather than stay at a constant level. Periods of worsened symptoms — known as flares — can last anywhere from a few hours to several weeks.

Flares are not random. Most people eventually learn to recognise their own personal triggers, though patterns can take months to identify.

Physical and environmental triggers

  • Overexertion. Doing more than usual — physical activity, housework, travel — often leads to a flare, sometimes with a delay of a day or two.
  • Poor sleep. A few nights of disrupted sleep can tip symptoms into a flare. Sleep and fibromyalgia are closely linked in both directions.
  • Weather changes. Many people report that cold, damp weather, or sudden shifts in barometric pressure, worsen symptoms. The evidence here is mixed, but the experience is consistently reported.
  • Illness or infection. Even minor infections can trigger significant flares.

Emotional, sensory, and lifestyle triggers

  • Emotional stress. Arguments, difficult news, or prolonged worry can all trigger flares. Positive stress — a big event, a holiday — can do the same.
  • Sensory overload. Loud environments, bright or fluorescent lighting, and strong smells can contribute to flare build-up.
  • Hormonal changes. Many women report flares linked to their menstrual cycle. Perimenopause and menopause can also bring significant shifts in symptoms.
  • Diet and dehydration. Some people identify specific food triggers. Dehydration and skipping meals are also common contributors.

Learning your triggers

Triggers vary widely between people. One person may find cold weather makes little difference but emotional stress is a reliable flare trigger. Another may be sensitive to food changes but unaffected by sleep disruption.

The most reliable way to identify your personal patterns is to keep a daily log of activities, environment, sleep, and symptoms. Patterns tend to emerge over several weeks — often showing connections that are difficult to spot in real time.

A simple paper diary works. Tracking apps such as Bearable or Visible add more detail if that is helpful.