Recurrent lightheadedness and fainting are common symptoms, as is an unusual difficulty with prolonged fatigue after a modest amount of physical activity. This post-exertional fatigue can last 24-72 hours, and interferes with many daily activities.
We have also observed that chronic fatigue, muscle aches (or fibromyalgia), headaches, and mental confusion can be prominent symptoms of neurally mediated hypotension even in individuals who do not faint. The mental confusion takes the form of difficulty concentrating, staying on task, paying attention, or finding the right words. Some describe being in a “mental fog.” It appears that as long as the fainting reflex is activated whenever the person stands or sits upright for a period of time, then the blood pressure is improperly regulated, and these symptoms are the result.