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I keep hearing about the “metabolic” type of PEM that causes extreme fatigue and burning in the arms and legs. I’m wondering if some people experience a more autonomic type of PEM instead — meaning no major fatigue, but a big flare in POTS symptoms and severe headache ?

For example, someone having a delayed reaction where about 24 hours after a 25‑minute walk they develop a severe headache and a big increase in POTS/tachycardia, without the classic exhaustion or muscle burning?

Thank you so much, wishing you all healing from all types of PEM 🙏