Brainfog and fatigue until the late afternoon or evening

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My name is Sem (male, 31 from Belgium), suffering from brainfog and fatigue for a long time (6 years) and hope to get some help on this forum. I will try to keep it short. (sorry for my english)


- I get up in the morning and after about 1-2 hours I get hit by brainfog (headache, pressure in my head, feeling heavy, problems to concentrate,feeling low...) and fatigue. Mostly these symptoms get better in the late afternoon. During the evening I feel normal most of the time. The difference between morning/afternoon and evening can be very big. When I go to sleep I feel pretty normal. After a good night of sleep (no sleeping problems) I wake up and the same pattern repeats itself. The severity of the symptoms can vary greatly depending on the period. One week I feel like a zombie all the time and can hardly function, the other week I feel tired but a lot better. I have no idea why. (I have tried to link it with food or sleep or stress but there is no clear correlation). The symptoms have a serious negative impact on my life.

In this 6 years I'v tried many things to figure out what is the problem:

- Endless blood tests. They where always fine.

- Urine tests. 

- Sleep study. No problems with sleep.

- Cortisol saliva test

- Ultrasound scan of the blatter and the kindeys

- eEg research

- CAT scan of the sinuses

- EMG research (not sure of the translation)

- CEIA bilan (not sure of the translation)

- Endless diets: Low-histamine diet, low-sugar diet, no-gluten diet, no-diary diet,...

- I tried a lot of supplements (for more then 3 months) but there is nothing that gives me a better feeling.

- Psychotherapy 

- Allergy test: I am allergic to histamine and mercury

- Food intolerance test: this is the only test where they found a potential cause of the symptoms. According to the test i'm intolerant to almond nuts, diary, gluten, yeast, eggs,  and bananas. I avoided these foods for 3 months without any results.

Is there somebody out there with similar symptoms? Is there somebody that can give me advice in my search for a better health? How can I get rid of these headaches and the fatigue?

Especially the difference between morning/daytime and eventing is very striking. It reminds me of adrenal insufficiency (the symptoms are very similar) but i have tested this and they seem to work normal (blood test and saliva test). 

I have no idea why this happens to me. I eat healthy (vegetarian, lots of vegetables, no fast food, a lot of whole foods, not a lot of sugars, not a lot of processed foods,...) and I do sports at least twice a week (only during the evening because during daytime it is difficult).

Hope to get some help here! Thanks in advance!



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  • Posted

    hi sem, have you had any luck figuring out what is causing these symptoms that are also dependent of time of the day?

    I have been dealing with the exact debilitating symptoms for over 2 years now. have gone through also many specialists and tests without any answers.

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  • Posted

    Hello Sem,

    I have a similar pattern of fatigue. I've had it for 15 years. It started off only affecting me in the morning, then it extended further into the day – late morning, lunchtime, late afternoon, until finally I only had a few hours in the evening when I felt normal. I feel very drained, also a bit faint, especially if I do any exercise. I also can't stand still for long e.g. in a queue. I look a bit pale in my face and people say I look tired. The fatigue seems to be located around and behind my eyes, in my head though, it's not actually tired eyes. (I don't usually have a headache though.)

    Once the feeling wears off, I feel completely normal, and quickly try to do chores and exercise late in the evening, like you do!

    I thought it might be reactive hypoglycemia, but having a snack doesn't seem to help so that may be ruled out – still trying to find out on that one. My other thought was a circadian/biorhythm disorder, but the specialists only seem to look at sleep problems, and I don't think it is a sleep problem. I will try to look at migraine next, although my symptoms don't really fit migraine. POTS seems ruled out because I don't have tachycardia.

    Nobody seems to be able to grasp the fact that it wears off at a certain time as being the key piece of information. They keep investigating vitamin deficiencies and other causes that couldn't possibly be causing symptoms that wear off every afternoon.

    It surely must relate to something cyclical in the body.


    Sarah (in Australia)

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  • Posted

    Hello Sem,

    One more thing – I have been reading a bit more about POTS and discovered that there are various forms of POTS, as well as a range of other autonomic disorders (dysautonomia) that can cause fatigue and headache, not necessarily involving tachycardia. I am not sure if you have been tested yet for this, but as you said you had headaches I just thought I'd mention it.

    One experiment would be to get out of bed one hour earlier or later, and see if your fatigue wears off one hour earlier or later. I haven't tried this myself because I am a bit unwell with another medical problem (unconnected) and am just too tired/disorganised at the moment.



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  • Posted


    I've endured identical symptoms and relief efforts since my CFS began ten years ago (after a severe bout of mono). I've since significantly adjusted my lifestyle -- I exercise daily (when possible) and eat very healthy (processed/grain/dairy-free, mostly fruit/vegetables/fish) which has helped but not sufficiently. After trying numerous doctors/supplements/therapies I finally tried low-dose Naltrexone and instantly realized astonishing results. My CFS (and recent rheumatoid arthritis) issues subsided and though minor setbacks persist two months into it (typical symptoms one day/wk, insomnia/vivid dreams side effects), I'm very optimistic as I experiment dosages/etc. (currently 2.5mg/day).

    I feel like I'VE GOTTEN MY LIFE BACK (!) and highly recommend any fellow CFS/MFS/RA sufferers to explore LDN. Please reply on your LDN experience if applicable... Thanks, Mike

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  • Edited

    I have the exact same symptoms.Are you sure it's not CFS?There aren't any tests to confirm or reject it so I doubt your doctors can say anything with certainty.For me PEM symptoms had at least 24 hours delay from anaerobic exercise so I wasn't aware of it for years because I didn't connect the dots.But I think PEM can hit much faster from aerobic exercise.

    Anyway your case looks like brain inflammation.There are a few things to try but what helped me was pramipexole, it was the only thing out of a ton of trials that worked and worked pretty well.It has a difficult titration up but once you get to the therapeutic dose and stay there about a week you will see the benefits.You start at 0.5mg and increase 0.5mg every week.You take one dosage at night, it will make you sleepy.As you are getting used to it you will get the opposite effect, it will make you more tired.You get used to a dosage when you stay at it for a week or more.As you go up you can make a stop at 1.5mg, which is at the lower range of the therapeutic dosage range, wait 7 days to start seeing the benefit and if it's not enough set the next goal to 2mg and do the same (wait 7+ days when you get there to gauge the 2mg dosage).

    The average working dosage according to Fawcett's study is 2.5mg (-+1mg).Don't let the diagnosis of the patients in the study let you down.It wasn't typical depression to begin with, those patients had an average of 6 failed drugs.Treatment resistant depression could be anything, perhaps something neurological that causes depression as a side effect but it isn't the main issue.Specifically, I suspect that almost all these patients had brain inflammation which caused the depression and the failure of the antidepressants, that's why pramipexole worked for 76% of them, when everything else failed.Pramipexole is protective and antiinflammantory in the brain.I hope you see this because I really think it will help you.I know how big of a journey this is, I was lucky to find this, I could have easily tried 10-20 more supplements/drugs and still be at square 1.

    Obviously you should ask a doctor about it.Mine was against it and that was the reason I quit it and tried his suggestion (wellbutrin) which has failed.I will negotiate getting back on pramipexole because I really thing he exaggerated the issues of this drug.In any case, if you decide to quit it you must be very careful to do it extremelly slowly, much more than titration up.You should reduce 0.25mg every 2 weeks.Good luck.

    Oh and yeah, I saw the comment above and I remembered that I am also using LDN.It does help with brain inflammation but very little in my case.In fact, when I was on both I attributed that feeling that something took care of that inflammation/fog to LDN, because I didn't know then that pramipexole has such properties.When I quit pramipexole and continued LDN the symptoms came back and I realized that pramipexole must have antiinflammantory effects in the brain, so I looked it up and it looks like it has, and quite much so.

    LDN is pretty harmless, you can add it anyway, just avoid opiods at least around the dosing time.

    I'd say that LDN gave at most 20% of the inflammation reduction, pramipexole gave at least 80%.

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  • Posted

    I fainted 3 years ago and hit the back of my head badly and have experienced these symptoms chronically since then. Mainly dizziness (especially in supermarkets or when i turn my head), fatigue and difficulty concentrating all while having dull pain in my neck.

    Ive tried every treatment, often with multiple practitioners and was getting no where. Then my 4th physio was a specialist in post-concussion syndrome and after a few massages and some excercises to strengthen my neck muscles, I feel a lot better! I believe the problem for me occurs because of injury to the sub-occipital region.

    I hope this helps someone, as I was so lost for a long time and frustrated that no doctors knew what to do.

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  • Edited

    Hello there. I have similar condition already for 10 years with better and worse periods.

    Usually I wake up and feel good and then after minutes up to 1 or 2 hours I start to feel brainfog, fatigue, can't focus, pressure in head, weird vision. This is going through day and then in late afternoon or in evening I start to feel normal and healthy again.

    Since doctors after many tests found nothing wrong with me, I was said it is psychological issue many years ago and I spent many years on antidepressants. Recently in two years out of antidepressants and I have no depression and anxiety is also very low levels. But my condition is same. I really don't think it is mental disorder since I tried so many drugs and nothing seemed to help.

    I can't find connection. I'm trying elimination diets since I also have problems with bowel movement and have pretty often diarrhea.

    Also in trying to find some connection with light. Eventually I exchange all my bulbs home to classics ones. I'm trying to to find any connection with LED screens since I also by light sensitivity and swelling eye lid. But to be honest I don't know if is this also related to original issue or is it another one caused by spend too much time to looking to PC.

    I'm trying to live as normal life as I can buy its hard to be honest.

    If anyone find what is wrong with us. Please let me know. It has really affected my life a lot in negative way and doctors gave up long time ago.

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    • Edited

      Hello Martin,

      Has anyone checked for POTS or orthostatic intolerance?

      Also, sinus problems or migraine?

      I feel fatigued, weak and have trouble concentrating in the morning too. Then it wears off and I feel normal in the evening.

      It's really hard waiting around most of the day to feel better ... I live in the country so there's not much to do at 10pm here!



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    • Posted

      Good evening, after reading your post, your symptoms are identical to mine except for the

      diarrhea. Even your description of issues with light match me. I am wondering if you have made any progress with your diagnosis? I have been dealing with this 5 months, the Doctors are just passing me around, they never have answers but they sure do get the bill out on time. My Primary Care Doctor wants to do a psychological evaluation and I think put me on anti-depressents just like they did to you. I know my problem is real, but if your Doctor does not believe you, your hopes of being properly diagnosed are slim. My wife and I are considering trying to involve the Cleveland Clinic, since several people seem to have had good luck with them. Do you have any advice or comments that might steer me in the right direction? Any help at all would be appreciated. Thanks so much in advance!

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