Fibromyalgia syndrome is most common in women, with the most common age of onset being 25-45 years. The clinical manifestations are varied, but there are four main groups of symptoms as described below. Widespread generalized pain is a symptom of all patients with fibromyalgia syndrome. Widespread generalized pain is common in all patients with fibromyalgia syndrome. It is especially common in the medial skeleton and the scapular and pelvic bands. Other common areas are, in order of prevalence, the knees, head, elbows, ankles, feet, upper back, mid-back, wrists, buttocks, thighs, and calves. Most patients describe this pain as a stabbing, excruciating pain. Patients often complain of periarticular swelling without objective signs. This is followed by headache and irritable bowel syndrome. Headaches can be categorized as migraine or non-migrainous headaches, the latter being a dull, pressing pain in the occipital region or throughout the head. Psychological abnormalities including depression and anxiety are also more common. In addition patients have a reduced ability to work, and a small number are unable to keep up with daily tasks. The above symptoms are often aggravated by cold weather, stress, and overwork, and can be alleviated by localized heat, mental relaxation, good sleep, and moderate activity.