BACKGROUND AND OBJECTIVE: The existence of fibromyalgia syndrome (FMS) has been debated, yet it is frequently encountered by primary care physicians and contributes to the high patient volume in neurology clinics. In India, detailed studies on fibromyalgia (FM) are lacking. This study was designed to assess the prevalence, clinical profile, and treatment outcomes of FMS in a neurology department of a government hospital in Northeast India. DESIGN: Hospital-based prospective observational study. MATERIALS AND METHODS: The study included adult patients aged 18 years and above attending the neurology outpatient department (OPD) who met the 2016 revision of the 2010/2011 American College of Rheumatology (ACR) FM criteria. A total of 942 FM patients underwent systematic neurological examinations, and their neurological symptoms were assessed with a standardized questionnaire. In-depth interviews were conducted, and demographic data, clinical profiles, and treatment outcomes were recorded. Patients were followed up for 6 months. RESULTS: Of 6,784 patients screened, 942 were diagnosed with FM, yielding a prevalence rate of 13.9%. The majority were female (90.9%). Homemakers and those in physically demanding jobs were more frequently affected. Cognitive behavioral therapy was provided to 59.9% of patients, while NSAIDs were given to 53.8% for symptomatic relief. At 6-month follow-up, 88.9% of patients reported significant improvement. CONCLUSION: The study reveals a substantial burden of fibromyalgia among neurology outpatients in Northeast India, particularly affecting females and those in physically demanding jobs. Early diagnosis and an integrated treatment approach are crucial for improving patient outcomes and quality of life.