What Triggers Fibromyalgia?

What triggered this?

Many of us living with fibromyalgia can point to a moment when our symptoms began or when we suddenly became much worse. I certainly remember mine.

This leads to an important question:

What triggers fibromyalgia?

While researchers still do not know the exact cause of fibromyalgia, studies suggest that symptoms often appear after a significant stressor to the body or nervous system. These stressors are called triggers.

A trigger does not necessarily cause fibromyalgia on its own. Instead, it may act as the spark that activates symptoms (flare days) in someone whose nervous system is already vulnerable.

For some, the onset is sudden and linked to a specific event. For others, symptoms develop gradually after years of accumulated physical and emotional stress.

Understanding common triggers can help you better understand their experience and begin identifying ways to support healing.

1. Illness or Infection

Many people report that their fibromyalgia symptoms began after a significant illness.

Research has identified several infections that may precede the onset of fibromyalgia, including:

• viral infections
• Epstein-Barr virus
• Lyme disease
• influenza or other respiratory infections
• gastrointestinal infections

Illness places stress on the immune system and nervous system. In some individuals, the body may struggle to fully return to its baseline afterward.

Researchers believe that infection may sometimes trigger long-term changes in pain processing and immune signaling, which may contribute to fibromyalgia symptoms.¹

2. Physical Injury or Trauma

Another common trigger is physical trauma to the body, such as:

• car accidents
• whiplash injuries
• falls
• sports injuries
• repetitive strain injuries

Physical trauma can disrupt the nervous system’s regulation of pain signals.

In some people, the nervous system becomes hyper-responsive after injury, meaning the brain continues to amplify pain signals even after tissues have healed.

This phenomenon is closely related to central sensitization, which plays a key role in fibromyalgia.

3. Surgery

For some individuals, fibromyalgia symptoms appear after major surgery or medical procedures.

Surgery can be a significant physiological stressor, involving:

• tissue trauma
• anesthesia
• inflammation
• immune activation
• disrupted sleep
• emotional stress

While most people recover normally after surgery, researchers believe that in susceptible individuals, the body’s stress response may remain activated, contributing to long-term pain sensitivity.²

4. Emotional or Psychological Stress

Emotional stress can also act as a trigger for fibromyalgia symptoms.

Examples include:

• loss of a loved one
• prolonged caregiving
• relationship trauma
• chronic work stress
• major life transitions

Stress activates the body's fight-or-flight system, which is controlled by the autonomic nervous system.

When stress becomes chronic, the nervous system may remain in a heightened state of alertness, which can increase pain sensitivity, disrupt sleep, and affect energy levels.

Importantly, this does not mean fibromyalgia is psychological. Instead, it highlights the deep connection between the nervous system, the brain, and the body.

5. Hormonal Changes

Hormonal shifts may also play a role in triggering or worsening fibromyalgia symptoms.

Fibromyalgia is significantly more common in women, and many people notice symptom changes during times of hormonal transition, including:

• perimenopause
• menopause
• postpartum changes
• significant menstrual cycle fluctuations

Hormones such as estrogen influence pain perception, inflammation, sleep regulation, and nervous system function.

When hormone levels fluctuate dramatically, they may contribute to changes in how the body processes pain.

6. Burnout and Chronic Stress

For some people, fibromyalgia symptoms appear after years of prolonged stress or overexertion, rather than a single identifiable event.

This may include periods of:

• extreme work demands
• caregiving responsibilities
• chronic sleep deprivation
• long-term emotional stress
• pushing through pain or exhaustion

Over time, chronic stress can place a heavy burden on the nervous system, immune system, and hormonal systems.

Eventually, the body may reach a point where it can no longer compensate, and symptoms emerge.

7. Cumulative Stress Load

One of the most important things researchers now recognize is that fibromyalgia often develops through cumulative stress on the body and nervous system.

Rather than one single trigger, symptoms may arise after a combination of factors such as:

• genetic vulnerability
• illness or infection
• trauma or injury
• chronic stress
• sleep disruption
• hormonal changes

When these factors accumulate, the nervous system may become more sensitive and reactive, eventually leading to the widespread pain and fatigue associated with fibromyalgia.

When There Is No Clear Trigger

It is also important to know that many people cannot identify a clear trigger for their fibromyalgia.

Symptoms may develop slowly over time without a single defining event.

This does not make the illness any less real or significant.

Fibromyalgia is a complex condition involving the brain, nervous system, immune system, sleep regulation, and stress physiology.

What This Means for Healing

Understanding triggers can be helpful because it often points to the systems most affected in fibromyalgia.

For many people, healing approaches focus on supporting these systems through:

• nervous system regulation
• improved sleep quality
• stress recovery
• gentle movement
• nutrition that supports inflammation balance
• pacing and energy management

While triggers may start the process, they do not determine the future of the condition.

Many people experience meaningful improvement as they learn to support their nervous system and overall health.

A Note From Lived Experience

After more than 25 years living with fibromyalgia, I have learned that many of us carry guilt or regret about what might have triggered symptoms.

But fibromyalgia is rarely caused by one single event.

For many of us, it is the result of a complex interaction between biology, life stress, and the body's natural stress responses.

Understanding triggers can help bring clarity, but it should never lead to blame.

Your body was responding to the conditions it experienced.

And with the right knowledge and support, it can also learn new patterns of healing.

Sources

1. Häuser W et al. Fibromyalgia pathophysiology. Nature Reviews Rheumatology.

2. Clauw DJ. Fibromyalgia: A clinical review. JAMA.

3. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Fibromyalgia overview.