Symptom	Nonpharmacologic treatments	Pharmacologic treatments (start at low doses)
Fatigue or brain fog	Cognitive pacing Memory aids (e.g., calendar reminders, alarms, calculator) Perform cognitive tasks lying down	Occasional use; beware of “push and crash”: Amantadine Armodafinil (Nuvigil) Caffeine Methylphenidate Modafinil
Gastrointestinal	Healthy diet Trial of elimination diets (e.g., aspartame, sugar, dairy, gluten-free)	If small intestinal bacterial overgrowth: Metronidazole (Flagyl) Oral vancomycin Rifaximin (Xifaxan)
Hypersensitivity to stimuli	Environmental controls to reduce light levels, sound levels, and temperature fluctuations	None
Immune dysfunction	Avoid crowds Frequent hand washing Mask in public	Selective use: Antiviral agents (e.g., acyclovir) Hydroxychloroquine Intravenous immunoglobulin Subcutaneous gamma globulin
Orthostatic intolerance	Avoidance of prolonged standing Compression stockings Electrolyte drinks Salt tablets	Alpha agonists Desmopressin Fludrocortisone Intravenous saline Low-dose beta blocker
Pain	Acupuncture Chiropractic therapy Dry needling Heat or cold packs Hydrotherapy Massage Pacing Physical therapy Transcutaneous electrical nerve stimulation	Antiepileptics Medical marijuana Muscle relaxers Naltrexone (Revia) Nonsteroidal anti-inflammatory drugs Serotonin and norepinephrine reuptake inhibitors Tramadol
Postexertional malaise	Assistive devices (e.g., scooter, shower chair, stair lift) Avoid triggers Disability benefits Handicap parking placard Home health aide Pacing Use symptom journal or activity tracker to learn limits Work or school accommodations	None
Sleep problems	Blue-light filter Ear plugs Eye masks Good sleep hygiene Light therapy Meditation and relaxation techniques	Alpha blockers Antiepileptics Antihistamines Benzodiazepines Eszopiclone (Lunesta) Low-dose tricyclic antidepressants Mirtazapine Muscle relaxers Suvorexant (Belsomra) Trazodone Zolpidem