Fibromyalgia is a frustrating beast.

It’s very hard to diagnose, with doctors resorting to this diagnosis after eliminating everything else with barrage after barrage of tests.

It’s even harder to treat. Or manage in day to day life.

Fibro patients try rafts of medications, physical and alternative therapies, and settle on the ones that help the most.

When you think you have a handle on the pain and fatigue, something triggers a flare.

Just as each person with fibromyalgia reacts differently to medications and treatments, everyone has their own set of triggers.

Hunting down these triggers takes time and is often frustrating.

Here are my top five triggers for making me writhe in pain, or collapse in exhaustion, as well as solutions to have fewer and gentler flares.

1. A sleepless night

This is by far the worst trigger for me. After a sleepless night I’m useless - my head is foggy, my vision is usually doubled, or at least unable to focus, my legs want to collapse with each step, I’m shaky, dizzy and often nauseous, and the pain, oy.

It’s a guaranteed severe headache. Bowel cramps (IBS) are almost a certainty. My legs ache, calves cramp, sciatic nerve twinges. Upper back and chest feel compressed, stiff and swollen.

Showering feels like a marathon, let alone making food. Don’t ask me to do any task that requires thinking!

Solution - take a long nap or two!

Unfortunately, I seem unable to nap unless extremely sick with a virus. Even a migraine doesn’t knock me out these days.

If naps would work for me, I’d take them, regularly!

2. A heated argument with my partner

I wasn’t sure whether this should go first or second. Arguments typically result in sleepless nights, and a lot of extra sinus pain from crying.

Big arguments are much worse.

Getting upset or angry is never a good idea when you are trying to keep your fibromyalgia in check.

When you get upset, your cortisol dips. But fibromyalgia patients have low cortisol levels all the time!

Low cortisol causes or worsens a bunch of fibromyalgia symptoms: depression, dizziness, confusion, weakness, fatigue, hypersensitivity, anxiety, muscle aches, skin sensitivity, nausea, bowel pain, clumsiness and more.

So an argument with a fibromyalgia sufferer lowers their already low cortisol, and worsens all of their symptoms.

In addition, heart rate and blood pressure increase, we tense up especially in the shoulders and neck, adding more pain and headaches, and restricting our already poor blood flow to our sore muscles.

Solution: learn to talk things out calmly, or take some time out (alone) to take the heat off.

Easier said than done!

My partner and I are getting better at this, and I’ve noticed fewer extreme flares as a result.

3. Over-exertion

This can be exercise, or it can be attending one too many social gatherings.

Any time we push past pain and fatigue limits, we invite a flare. Overdoing cleaning, cooking, walking, or anything counts.

Studies show that exercise induced hormones do not increase in fibromyalgia patients to the same degree as healthy exercising people. This means we get exhausted quicker. We can’t go as intense or as long as ‘normal’ people.

Plus we start out at a disadvantage because we constantly struggle with stiffness, pain and low energy.

We don’t get as much benefit from intense exercise (anti-depressing hormones or cardio improvements).

However daily, gentle exercise has an anti-inflammatory effect on fibromyalgia, especially when done in warm water. This is a good thing, because most fibro sufferers have chronic low-level inflammation.

Solution: habitual moderation

  • Daily exercise is important for fibro patients - it helps build muscle strength, strengthens the heart, and actually gives us a much needed boost in cortisol, albeit a small one. But don't jump into a full gym routine, or go for a 10km walk. Start very gently, and build up very slowly. Try warm water aerobics!
  • Space out your socialising, no binging on events. Get people to visit you instead of heading out.
  • Don't clean the entire house at once, do a small bit each day. Hire a cleaner (or rope in a friend).
  • Cook extras and freeze them. Pasta sauce, chilli, curry, soups, and stews are great. The preparation work for a larger amount of many meals is not much extra, and you get a few nights where you don't need to cook.

4. Stress

When someone is stressed, their hormones and neurotransmitters respond - lowered growth hormones, androgens, estrogens, and serotonin are all reduced, while substance P is increased.

That means healthy people get grumpy, tired, headachey and have sleeping problems and aching muscles when stressed. Chronic stress can lead to burnout and depression in otherwise healthy people.

One study found that the hormone and neurotransmitter stress response of healthy people matched fibromyalgia patients’ baseline.

So, our bodies are always ‘stressed’, even when there is nothing to be stressed about.

We need to avoid adding more stress to our already burdened bodies!

Solution: constant stress management

It’s important that we incorporate stress management techniques into our daily lives.

  • Simplify commitments and routines.
  • Lessen contact with stressful people.
  • Meditate, do tai chi, yoga, or another physical therapy for stress relief.
  • Hug someone, or belly laugh.
  • Eat less of things which can aggravate the stress response: caffeine, sugar, alcohol.
  • Take a bath or read for fun.

5. Illness or injury

No one enjoys being ill or healing from an injury. For most healthy people, it’s an inconvenience, if somewhat painful.

For fibromyalgia patients, being ill makes all our other symptoms so much worse.

We already struggle with energy levels and pain on a daily basis, so adding in the tiring healing process and the pain directly caused by the illness/injury and it can trigger a massive fibro flare.

Solution: get help when you are ill, and try to prevent illnesses

  • Put aside cleaning and cooking as much as possible, and spend your energy on healing when you are sick.
  • Ask friends and family for help.
  • When you know a cold virus has infested the population, try to avoid people as much as possible. Public transport, shopping centers, doctors' waiting rooms and schools are particularly bad.
  • Ask friends and family to stay away if they or anyone in their immediate family are sick.
  • Think about getting a flu shot, if it's recommended for you.
  • Go Japanese, and wear a face mask.
  • Don't freeze or overheat in cold/hot weather. Use cool foot baths and towels to stave of heat exhaustion, invest in heat packs and heated blankets for wintry weather.
  • And layer, layer, layer in winter - going from the freezing outside to an overheated room is hard on fibromites and can increase our chance of getting ill!

Your turn

What tips and tricks do you use to beat the top five things that make fibromyalgia worse?