Shingles, or herpes zoster, is an extremely common viral infection. It may cause a range of symptoms, including a skin rash and fatigue. Some people may feel tired even after the shingles rash has cleared.

The same virus that causes chickenpox, the varicella-zoster virus (VZV), also causes shingles. After a person recovers from chickenpox, VZV remains in their body. If the virus reactivates, it can trigger shingles later in life.

This article discusses the symptoms of shingles, causes of fatigue after recovering from shingles, ways to manage shingles fatigue, and when to speak with a healthcare professional.

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Shingles often starts with several days of itching, tingling, or pain at the future site of the rash. The virus may then trigger the following symptoms:

  • a tender, painful skin rash, usually on one side of the body or in a single stripe on one side of the face
  • vision loss if a shingles rash affects the eye
  • stomach problems
  • chills
  • headache

A person may also experience tiredness, or fatigue, while they have shingles.

In some cases, even after the shingles rash resolves, complications may develop that cause a person to experience fatigue and other symptoms.

Postherpetic neuralgia (PHN)

PHN causes at least 3 months of burning, aching, or throbbing nerve pain after a person’s shingles rash heals. It develops in the original area of the rash.

The condition develops in 10–18% of people who have shingles, and the risk increases with age. Older adults with shingles have a higher risk of longer lasting, severe PHN, while those who develop shingles under 40 years of age often do not often experience PHN at all.

Not everyone who develops PHN will experience fatigue. However, those with especially long lasting or painful PHN may experience:

These complications can last for months or years. However, they eventually resolve in most people.

Chronic fatigue syndrome (CFS)

CFS, which people may also call myalgic encephalomyelitis (ME), is a condition that causes disabling, constant tiredness. A doctor may diagnose CFS if:

  • A person has felt this level of fatigue for more than 6 months.
  • The tiredness has not developed from high energy activities, is not lifelong, and does not resolve after sleep.
  • Fatigue is causing cognitive problems, such as issues with memory and attention.
  • Symptoms worsen when a person assumes or maintains an upright posture.

It is not clear what causes CFS, but the Centers for Disease Control and Prevention (CDC) have identified immune system changes, stress, infections, genetics, and changes in the way the body makes energy as possible causes.

The CDC reports that symptoms qualifying for CFS diagnosis develop in around 1 in 10 people who contract Ross River virus, Epstein-Barr virus, or Coxiella burnetti.

Some researchers have looked into a connection between shingles and CFS.

An older 2009 review suggested a possible link resulting from VZV’s ability to remain inactive in nerve cells after a person experiences chickenpox. Another older study from 2014 found that a group of 9,205 people with previous experience of shingles had a higher rate of CFS than a group of 36,820 people who had never had shingles.

However, studies investigating whether shingles may trigger CFS are limited, and further research is necessary.

People who experience fatigue due to shingles may try the following tips to reduce the symptom:

  • Make a sleep routine, but start by restricting sleep: Try to sleep for a set amount of time at a specific time. While pain may make falling asleep difficult, restricting sleep to 4 hours at first might help someone spend the entire time in bed sleeping. A person may gradually increase sleep by 15–30 minutes per night until they start to feel more rested.
  • Eat low glycemic index foods: This category includes foods such as whole grains, vegetables with high fiber content, nuts, and healthy oils. These foods release energy slowly, which may help prevent energy lag and sugar crashes.
  • Drink plenty of water: Tiredness is one of the earliest symptoms of dehydration. People should make sure to drink water regularly.
  • Find healthy ways to manage stress: Stress is a possible trigger for herpes zoster and may worsen symptoms. Stress may also make fatigue worse. Stress management may involve deep breathing techniques, meditation, yoga, doing fun activities, or talking with a loved one about sources of stress.
  • Manage priorities: Working too much can contribute to fatigue, especially if PHN pain stops someone from getting a good night’s sleep beforehand. A person may consider focusing on any unavoidable tasks and taking on fewer extra obligations in professional and personal life.

If a person still finds fatigue unmanageable or too much to cope with, they may benefit from speaking with a mental health professional or finding a PHN support group.

A person should speak with a doctor if they notice any symptoms of shingles or any pain after the shingles rash heals.

Healthcare professionals may help someone manage PHN pain and resulting fatigue by prescribing medications such as tricyclic antidepressants and topical pain relief medications.

A doctor can also administer vaccines to prevent shingles and, therefore, any of its potential complications. The CDC recommends the vaccine for those ages 50 years and over, as the risk of shingles and its complications increases with age.

A person may experience fatigue while they have shingles or as part of a complication of shingles, such as PHN or potentially CFS.

People who experience fatigue due to shingles can try to limit this symptom by changing their sleep routine, diet, and stress management techniques. If fatigue persists, they should speak with a healthcare professional for further advice.

The shingles vaccine can help reduce the risk of shingles and its complications.