Pain, fatigue, sleep and headache

Understand why these symptoms matter without presenting them as positive signs of FND or prescribing a single management plan.

Pain, fatigue, sleep and headache

Pain, fatigue and sleep disturbance are common and important in people with FND, but they are associated symptoms rather than positive diagnostic signs of FND. Migraine is a separate neurological diagnosis that can coexist with FND.

What to do next: Keep each symptom and each diagnosed or unresolved condition visible in its own right.

Important limit: This page cannot decide whether FND, another condition or several contributors explain an individual's symptom.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
Diagnosis and management of FND — Aybek S, Perez DL. Diagnosis and management of functional neurological disorder. BMJ. 2022;376:o64.
Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
Epilepsy and functional seizures coexist — Kutlubaev MA, Xu Y, Hackett ML, Stone J. Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: systematic review and meta-analysis. Epilepsy Behav. 2018;89:70-78.
Functional gait sign-based approach — Nonnekes J, Ruzicka E, Serranova T, Reich SG, Bloem BR, Hallett M. Functional gait disorders: a sign-based approach. Neurology. 2020;94(24):1093-1099.
Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
Pain and FND meta-analysis — Steinruecke M, Mason I, Keen M, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. JNNP. 2024;95(9):874-885.
Sleep and FND meta-analysis — Kannan S, et al. Sleep disorders in functional neurological disorder: a systematic review and meta-analysis. Neurol Sci. 2025;46(4):1573-1580.
Dissociation and FND meta-analysis — Campbell MC, et al. Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis. BJPsych Open. 2023;9(1):e2.
Positive-sign accuracy review — Patwal R, Jolly AJ, Kumar A, Yadav R, Desai G, Thippeswamy H. Diagnostic accuracy of clinical signs and investigations for functional weakness, sensory and movement disorders: a systematic review. J Psychosom Res. 2023;168:111196.
FND manifestations and comorbidities survey — Alexandra Ducroizet, Ioanna Zimianti, Dawn Golder et al. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci. 2023;110:116-125.
Overall FND comorbidities review — Guilhem Carle-Toulemonde, Julie Goutte, Nathalie Do-Quang-Cantagrel et al. Overall comorbidities in functional neurological disorder: A narrative review. Encephale. 2023;49(4S):S24-S32.
International FND patient survey — Matthew Butler, Oliver Shipston-Sharman, Mathieu Seynaeve et al. International online survey of 1048 individuals with functional neurological disorder. Eur J Neurol. 2021;28(11):3591-3602.
NICE headache and migraine guideline — National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated 3 June 2025.

Last checked: 2026-07-16

Jurisdiction: UK

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Correction route: Report changed or inaccurate information without including personal health information.

Four families, not one FND pattern

These symptoms sit together for calm navigation, while their medical distinctions stay visible.

Pain: may be primary, secondary to another condition, associated with FND or have more than one contributor.
Fatigue: may be disabling and may also relate to sleep, pain, migraine, medicines, mood, endocrine or metabolic illness, infection, autonomic conditions or another diagnosis.
Sleep: sleep disturbance is not one diagnosis; persistent insomnia and suspected sleep apnoea have their own assessment routes.
Migraine and headache: migraine keeps its own diagnosis and care; a new headache pattern should not be assumed to be FND or familiar migraine.

What to do next: Use the closest family to prepare the right clinical question, not to decide the cause yourself.

Important limit: A descriptor, overlap or group statistic cannot diagnose an individual symptom.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

FND subtypes and shared mechanisms — Hallett M, Aybek S, Dworetzky BA, McWhirter L, Staab JP, Stone J. Functional neurological disorder: new subtypes and shared mechanisms. Lancet Neurol. 2022;21(6):537-550.
Overall FND comorbidities review — Guilhem Carle-Toulemonde, Julie Goutte, Nathalie Do-Quang-Cantagrel et al. Overall comorbidities in functional neurological disorder: A narrative review. Encephale. 2023;49(4S):S24-S32.
Cognition across FND, fibromyalgia and CFS — Tiago Teodoro, Mark J Edwards, Jeremy D Isaacs A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308-1319.
FND manifestations and comorbidities survey — Alexandra Ducroizet, Ioanna Zimianti, Dawn Golder et al. Functional neurological disorder: Clinical manifestations and comorbidities; an online survey. J Clin Neurosci. 2023;110:116-125.
International FND patient survey — Matthew Butler, Oliver Shipston-Sharman, Mathieu Seynaeve et al. International online survey of 1048 individuals with functional neurological disorder. Eur J Neurol. 2021;28(11):3591-3602.
Pain and FND meta-analysis — Steinruecke M, Mason I, Keen M, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. JNNP. 2024;95(9):874-885.
NICE chronic pain guideline — National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s. NG193. 2021.
Practical management review — Dworetzky BA, Baslet G. Functional neurological disorder: practical management. Neurotherapeutics. 2025;22:e00612.
NHS insomnia page — NHS. Insomnia.
NHS long-COVID page — NHS. Long COVID.
Sleep and FND meta-analysis — Kannan S, et al. Sleep disorders in functional neurological disorder: a systematic review and meta-analysis. Neurol Sci. 2025;46(4):1573-1580.
NHS sleep-apnoea page — NHS. Sleep apnoea.
Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
NICE headache and migraine guideline — National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated 3 June 2025.
NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.

Assessment keeps separate causes and diagnoses open

The useful question is not simply whether a symptom is 'part of FND', but what has been assessed, which diagnosis applies and which problems need parallel care.

Pain assessment may distinguish chronic primary pain, chronic secondary pain, fibromyalgia, complex regional pain syndrome or another contributor.
Fatigue assessment considers the pattern, impact and possible sleep, medicine, migraine, mood, infection, endocrine, metabolic, autonomic and other contributors.
Sleep assessment may include a sleep history, medicine review and testing where sleep apnoea is suspected.
Headache assessment considers whether this is an established migraine pattern or something new or atypical.

What to do next: Ask which problem is being assessed, which clinician owns it and what would change the current plan.

Important limit: This is not an exhaustive differential, diagnostic checklist or instruction to request a particular test.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

Pain and FND meta-analysis — Steinruecke M, Mason I, Keen M, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. JNNP. 2024;95(9):874-885.
NICE chronic pain guideline — National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s. NG193. 2021.
Cognition across FND, fibromyalgia and CFS — Tiago Teodoro, Mark J Edwards, Jeremy D Isaacs A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308-1319.
NHS fibromyalgia diagnosis page — NHS. Fibromyalgia: diagnosis.
Practical management review — Dworetzky BA, Baslet G. Functional neurological disorder: practical management. Neurotherapeutics. 2025;22:e00612.
Overall FND comorbidities review — Guilhem Carle-Toulemonde, Julie Goutte, Nathalie Do-Quang-Cantagrel et al. Overall comorbidities in functional neurological disorder: A narrative review. Encephale. 2023;49(4S):S24-S32.
NHS insomnia page — NHS. Insomnia.
NHS long-COVID page — NHS. Long COVID.
NHS sleep-apnoea page — NHS. Sleep apnoea.
Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
NICE headache and migraine guideline — National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated 3 June 2025.
NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
NHS England FND minimum services — NHS England. Annex A: Specialised Neurology Service Specification—Minimum Services for Neurology Subspecialties. August 2025.
England adult specialised neurology specification — NHS England. Specialised neurology services (adults): service specification. Effective 1 April 2026.
NHS booking and referral standard — NHS England. NHS Booking and Referral Standard. Accessed 14 July 2026.
NICE ME/CFS guideline — National Institute for Health and Care Excellence. ME/CFS: diagnosis and management. NG206. 2021.
NICE long-COVID guideline — National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NG188. Updated 25 January 2024.

New or concerning patterns still need reassessment

A previous FND, pain, fatigue, sleep or migraine diagnosis should not hide a substantial change. New headache patterns, atypical neurological features, changed pain, witnessed breathing pauses during sleep or another medically concerning development need appropriate assessment.

Describe what is new or different and when it began.
Use ordinary urgent or emergency routes for an acute or severe presentation that needs prompt assessment.
Do not use a symptom diary or familiar diagnosis as proof that a new event is safe or has the same cause.

What to do next: Use the NHS route that fits the current situation rather than waiting for an FND service to classify the change.

Important limit: This page does not reproduce a complete headache or emergency red-flag list and cannot assess severity online.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

NICE NG127 referral — National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral (NG127). Updated 2 October 2023.
NICE FND quality statement — National Institute for Health and Care Excellence. Quality statement 5: Functional neurological disorders in adults (QS198). 2021.
Cautionary diagnostic notes — Perez DL, Aybek S, Popkirov S, et al. Cautionary notes on diagnosing functional neurologic disorder as a neurologist-in-training. Neurol Clin Pract. 2021;11(1):e72-e76.
Misdiagnosis in both directions — Walzl D, Carson AJ, Stone J. The misdiagnosis of functional disorders as other neurological conditions. J Neurol. 2019;266(8):2018-2026.
NICE chronic pain guideline — National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s. NG193. 2021.
NHS sleep-apnoea page — NHS. Sleep apnoea.
NHS insomnia page — NHS. Insomnia.
NICE headache and migraine guideline — National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated 3 June 2025.

Plans may need to be coordinated rather than combined

Pain, migraine, sleep disorders, fatigue and other diagnosed conditions may need their own treatment alongside FND care. Improvement in one problem does not guarantee that another will improve by the same amount.

A medicine should have a documented reason, expected benefit, possible burden and review owner.
Where FND rehabilitation could conflict with ME/CFS, long-COVID or autonomic guidance, the responsible clinicians should reconcile the plans for the individual.
Generic advice to push through symptoms must not replace condition-specific precautions, including post-exertional malaise guidance where relevant.

What to do next: Ask who is responsible for coordinating the plans and which goals or precautions belong to each condition.

Important limit: This page gives no treatment ranking, medicine instruction, activity prescription or universal pacing or exercise plan.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

Pain and FND meta-analysis — Steinruecke M, Mason I, Keen M, et al. Pain and functional neurological disorder: a systematic review and meta-analysis. JNNP. 2024;95(9):874-885.
Cognition across FND, fibromyalgia and CFS — Tiago Teodoro, Mark J Edwards, Jeremy D Isaacs A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry. 2018;89(12):1308-1319.
NICE ME/CFS guideline — National Institute for Health and Care Excellence. ME/CFS: diagnosis and management. NG206. 2021.
Physiotherapy consensus — Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry. 2015;86:1113-1119.
Physio4FMD phase 3 RCT — Nielsen G, Buszewicz M, Stevenson F, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial. Lancet Neurol. 2024;23:675-686.
NICE long-COVID guideline — National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NG188. Updated 25 January 2024.
NHS PoTS page — NHS. Postural tachycardia syndrome (PoTS).
FND treatment umbrella review — Mavroudis I, Petrides F, Franekova K, et al. Treatment of functional neurological disorder: an umbrella review of systematic reviews and meta-analyses. J Neurol. 2025;272:710.
AAN clinician summary — American Academy of Neurology. Management of Functional Seizures: Clinician Summary. Practice guideline; December 2025.
AAN functional-seizure guideline — Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106:e214466.
Practical management review — Dworetzky BA, Baslet G. Functional neurological disorder: practical management. Neurotherapeutics. 2025;22:e00612.
NHS England FND minimum services — NHS England. Annex A: Specialised Neurology Service Specification—Minimum Services for Neurology Subspecialties. August 2025.
Sleep and FND meta-analysis — Kannan S, et al. Sleep disorders in functional neurological disorder: a systematic review and meta-analysis. Neurol Sci. 2025;46(4):1573-1580.
Migraine and FND overlap — Stone J, Coebergh JA, Khoja L, et al. Migraine and functional neurological disorder: a review of comorbidity and potential overlap. Brain Commun. 2025;7(4):fcaf288.
Scotland FND pathway — NHS Scotland Centre for Sustainable Delivery. Functional Neurological Disorder pathway. Current at 14 July 2026.

Prepare a clearer picture for the next contact

A brief record can help separate patterns and impacts without producing an online diagnosis.

Use your own words and note when the symptom happens and one activity it interrupts.
Record what is established, what is new or changed and which diagnoses are still being assessed.
List medicines and which problem each is intended to treat; do not change them from this page.
Note any existing condition-specific plan or precaution that another clinician should see.

What to do next: Use Treatment and living to prepare questions, or Find help to understand available assessment and support routes.

Important limit: A diary or preparation note cannot diagnose a condition, measure medical risk or select treatment.

Sources and review information

Status: Owner released - source checked

Evidence check: Mapped to checked master-register claims

Jurisdiction: UK

Last checked: Check the linked live source

Prepared by: Project editorial team

Owner release date: 2026-07-22

Independent review: Not independently reviewed

Corrections: Use the site correction route without including personal health information.

NHS England FND minimum services — NHS England. Annex A: Specialised Neurology Service Specification—Minimum Services for Neurology Subspecialties. August 2025.
England adult specialised neurology specification — NHS England. Specialised neurology services (adults): service specification. Effective 1 April 2026.
NHS booking and referral standard — NHS England. NHS Booking and Referral Standard. Accessed 14 July 2026.
NICE headache and migraine guideline — National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated 3 June 2025.
NICE chronic pain guideline — National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s. NG193. 2021.
NICE ME/CFS guideline — National Institute for Health and Care Excellence. ME/CFS: diagnosis and management. NG206. 2021.
NICE long-COVID guideline — National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NG188. Updated 25 January 2024.
Practical management review — Dworetzky BA, Baslet G. Functional neurological disorder: practical management. Neurotherapeutics. 2025;22:e00612.
AAN clinician summary — American Academy of Neurology. Management of Functional Seizures: Clinician Summary. Practice guideline; December 2025.
BPS FND psychology guidance — British Psychological Society. Functional Neurological Disorder: Neuropsychological and psychological management in children and adults. Division of Neuropsychology Policy Unit FND Working Group. 2024.
Wales FND national optimal pathway — NHS Wales Performance and Improvement, Neurological Conditions Network. National Optimal Pathway for Functional Neurological Disorder: adults aged 16 and over. March 2026.
UK community OT barriers — Nicholson C, Francis J, Nielsen G, Lorencatto F. Barriers and enablers to providing community-based occupational therapy to people with functional neurological disorder: an interview study with occupational therapists in the United Kingdom. Br J Occup Ther. 2022;85:262-273.
Journey to diagnosis and care — Pritomanova S, et al. The journey to diagnosis and care of functional neurological disorder. PLoS One. 2026;21:e0328321.