Fibromyalgia is a bewildering and largely misunderstood disorder characterized by widespread pain and tenderness accompanied by fatigue, sleep problems, memory issues, and gastrointestinal concerns. Because the array of possible symptoms is so extensive (and there remains no clear consensus on how to diagnose the disorder), many feel lost as to what is affecting them and what to do about it. The most important thing to remember is that fibromyalgia pain symptoms may be poorly understood, but it is very real.

Here are the most common fibromyalgia pain symptoms and how to deal with them.

1. Widespread pain

Do you know how you used to feel after pulling an all-nighter at varsity? That’s the best way to describe how it feels to live with fibromyalgia pain symptoms, says Dr. Kim. “You don’t feel refreshed when you wake up, but rather stiff, achy, really run down and in pain.”

Fibromyalgia pain symptoms are thought to trigger something called central sensitization, which means your body “starts to get overly sensitive and react to things that normally wouldn’t hurt,” says Dr. Kim. There are pain medications your doctor can prescribe to help, but Dr. Kim recommends trying other options before medication, like aerobic conditioning workouts (think walking, jogging, cycling, swimming) and acupuncture, which have both been shown to help ease fibromyalgia pain symptoms.

2. Fatigue

Along with pain comes a general sense of tiredness that just won’t go away, says Dr. Kim, even after a good night of sleep. Doctors aren’t sure if patients are tired because of the pain they’re dealing with, or if their fatigue is causing the pain because they’re not getting proper muscle recovery when they sleep. “It’s sort of a chicken and egg question; we’re not sure which comes first,” says Dr. Kim. He recommends acupuncture and mindfulness practices to help people with fibromyalgia pain symptoms get better sleep and improve their fatigue.

3. Migraines

Severe headaches and migraines are other fibromyalgia pain symptoms. It’s also unclear what the direct cause of these are, but they could be another aspect of the overall chronic pain of the condition. Over-the-counter meds can help, as well as managing pain through methods like exercise and massage.

4. Sleep issues

People with fibromyalgia pain symptoms often report having sleep issues like waking up frequently or not being able to fall asleep, says Dr. Kim. Again, doctors aren’t sure if the disturbances are caused by pain and discomfort waking people up and making it difficult for them to fall asleep, or something else entirely. But issues like these only make the fatigue worse. Biofeedback therapies, self-guided imagery, and hypnosis and meditation are methods people can try to help with sleep issues, says Dr. Kim.

5. Brain fog

Many people with fibromyalgia pain symptoms experience “fogginess of thought” or “fibro fog”, says Dr. Kim. That might mean they have memory issues, or just feel like they’re not as sharp or quick in their thinking. “If you examine patients who have fibromyalgia pain symptoms, there are differences in their brain activity from people who don’t have it, in terms of metabolic activity,” says Dr. Kim. Doctors aren’t sure yet what that means, but they do know there are brain changes that could cause issues.

6. Depression and anxiety

Mood disorders are also associated with fibromyalgia pain symptoms and chronic pain conditions in general. “The neurotransmitters that impact depression are also tied to pain,” says Dr. Kim. It’s not clear how they’re connected, and it’s possible to have depression and anxiety that are separate from and not caused by fibromyalgia, but they may be linked. People should evaluate their mental health with a therapist or other mental healthcare provider, recommends Dr. Kim. “We can’t just focus on relieving pain; we want to make sure we’re addressing any psycho-emotional issues in addition to pain,” says Dr. Kim. “Some people’s pain might improve but their mood may not – the interplay is very complex, so it’s important to address the physical symptoms and the mental.”

7. Irritable bowel syndrome

People with fibromyalgia pain symptoms may also get upset stomachs and nausea regularly, and may have to go to the bathroom frequently, says Dr. Kim. People who do have irritable bowel symptoms should have their doctor or a gastroenterologist run checks to make sure everything is working properly, then consult with a dietitian about what nutrition deficiencies might be at play and what diet changes could help.