Which infections or injuries are most linked to starting fibromyalgia?

The short version: Epstein-Barr virus, whiplash injury, and emotional trauma have the strongest documented links to starting fibromyalgia. The evidence is thin for most other triggers.

The best-documented infectious trigger is Epstein-Barr virus (EBV), the virus that causes mononucleosis. A 1997 study found that emotional trauma—including family death and marital stress—raised the odds of developing fibromyalgia by about 13 times compared to people without such trauma [9]. Physical trauma like car accidents and surgery also raised the odds, but the link was weaker and did not reach statistical significance in that study [9].

Whiplash injury from motor vehicle collisions is the most studied physical trigger. One study found that about 14 percent of people with persistent neck pain after whiplash met the diagnostic criteria for fibromyalgia [11]. Another review reported that 85 percent of whiplash patients had myofascial trigger points, which often overlap with fibromyalgia pain patterns [10].

The evidence here does not include large controlled studies that compare infection rates between people who later develop fibromyalgia and those who do not. The EBV link comes from case reports and from studies showing that EBV can trigger other chronic conditions like Guillain-Barré syndrome and dysautonomia [7, 8]. Outside this retrieval, the broader literature also links Lyme disease, hepatitis C, and influenza to fibromyalgia onset, but those studies were not surfaced here.

My call: emotional trauma and whiplash injury have the strongest evidence for triggering fibromyalgia. EBV infection is plausible but less well documented. Confidence: moderate.