Long COVID and ME/CFS are real, diagnosable, and treatable — right now, with currently available interventions. You deserve a provider who understands the full picture and has a plan.
▶ Watch: Understanding Long COVID · 30 minWhether you're seeking care or trying to provide it better, there's a path here for you.
Long COVID and ME/CFS have identifiable, treatable sub-syndromes. Telehealth across 10 states — insurance-based in Massachusetts and New England, self-pay everywhere else on the licensed list.
Find My Care Path →Not looking for ongoing specialist care — but need a clear, documented framework your PCP can act on? The Diagnostic Framework Consultation produces a written clinical summary and treatment sequence from a focused intake and follow-up.
Learn About the Consultation →A sub-syndrome–based framework lets you apply existing evidence from ME/CFS, dysautonomia, migraine, and autonomic medicine to your Long COVID patients — without waiting for Long COVID–specific trials.
See Clinical Resources →Most patients don't arrive with a clear diagnosis — they arrive with a pattern of experiences that haven't been named yet. Select anything that sounds familiar.
This delayed pattern — feeling okay in the moment, then hitting a wall hours or days later — is one of the most diagnostically important features in Long COVID. The delay makes it easy to misattribute ("I must have been coming down with something") and even easier for providers to dismiss. It's a recognizable phenotype that points toward specific treatment targets, not toward pushing harder or exercising through it.
Positional worsening — symptoms that reliably appear or intensify with upright posture and improve when lying down — is a hallmark of dysautonomia and orthostatic intolerance. It's frequently dismissed as deconditioning or anxiety, but it has a physiological mechanism and responds well to targeted treatment. The NASA Lean Test in the free tracker app can help you document this pattern before your first appointment.
Heightened sensitivity to sensory input — not just headaches, but fatigue, brain fog, and systemic crashes triggered by what seem like ordinary stimuli — reflects a central sensitization process. Migraine is the most widely studied example, but the sensitivity pattern extends far beyond headache. Most providers don't recognize it as a coherent treatable sub-syndrome, which is why it's so often attributed to anxiety or psychological causes.
"Your tests are normal" is one of the most common and most damaging phrases in Long COVID care. Standard workups are designed to detect structural damage or biochemical abnormalities — they aren't designed to detect dysautonomia, central sensitization, or sleep architecture disruption. A normal workup means the labs didn't find what they were looking for. It doesn't mean nothing is wrong.
Learn about care options that go beyond the standard workup →
Long COVID doesn't divide neatly along specialty lines. A cardiologist managing the POTS, a neurologist managing the headaches, and a rheumatologist ruling out lupus may each be doing their job correctly while the patient gets no better — because the conditions are expressions of overlapping sub-syndromes that need to be addressed together and in the right sequence. The referral model wasn't built for this.
See how the Diagnostic Framework Consultation approaches this differently →
New or worsened reactivity — to foods, fragrances, medications, heat, cold, or other previously tolerated exposures — can indicate mast cell activation syndrome (MCAS), which frequently co-occurs with dysautonomia and central sensitization in Long COVID. It's often underdiagnosed because it doesn't show up on standard allergy testing and its presentations are variable and confusing.
Non-restorative sleep — logging the hours but not the depth — is one of the most underappreciated drivers of every other Long COVID symptom. Sleep isn't just rest; it's active neural maintenance, including glymphatic clearance in the brain. Disrupted sleep architecture amplifies fatigue, brain fog, pain sensitivity, and autonomic instability. And disrupted sleep in Long COVID is rarely fixed by sleep hygiene alone.
Recognizing a pattern in yourself isn't a diagnosis — but it's a productive starting point. Contact the practice →
When care focuses primarily on the chief complaint — fatigue, brain fog, shortness of breath — the workup often leads to dead ends. These symptoms frequently represent the downstream effects of multiple distinct, treatable sub-syndromes.
The sub-syndrome model — dysautonomia, central sensitization/migraine, MCAS, disordered sleep, cognitive dysfunction, and hypermobility — allows us to draw on robust evidence from adjacent fields and apply it systematically. Treatment is sequenced: foundational pillars first, pharmacology in support.
Where Long COVID–specific controlled trials exist, they guide the approach. Where they don't, the framework draws from well-controlled literature in ME/CFS, fibromyalgia, migraine, and autonomic medicine — conditions with meaningful overlap and decades of evidence.
Dysautonomia · Central Sensitization & Migraine · MCAS · Disordered Sleep · Brain Fog / PEM · Hypermobility
Hydration optimization · Nutrition & food trigger avoidance · Sleep quality · Behavioral & emotional regulation
"Migraine is not a headache disorder. It's a sensory processing disorder — and it's nearly universal in Long COVID. Most providers are treating the wrong target."
— Dr. Joshua Claunch, MD
"Post-exertional malaise" is a description, not a diagnosis. Identifying which crash pattern predominates changes every treatment decision that follows.
Many patients have more than one pattern operating simultaneously. Identifying the dominant pattern is the first step — because treating the wrong target doesn't just fail to help, it can actively worsen the other patterns. Read more about crash patterns →