The pain may begin in a localized area, often in the neck and shoulders, and then spread over a period of time to other parts. In more than 80 percent of patients, the neck and shoulders, mid and lower back are involved, and eventually complaint of weakness after minimal activity or exercise. Profound fatigue is especially part of the diagnosis with frequent arousals during the night. Gastrointestinal symptoms or irritable bowel syndrome are reported in 50 to 80 percent of the patients. Muscular or tension headaches are common.
Some patients report a history of migraine headaches.
These patients characteristically consult many physicians without much benefit. Many of them find their way to the acupuncturist with little or no relief. It actually requires very little training on the part of the physician to recognize and detect multiple tender points following a pain chart where these points are located. The diagnostic criteria require at least 11 out of 18 of these points as the criteria for the diagnosis of fibromyalgia. Insertion of the suboccipital muscle.