There may be significant involvement of the autonomic nervous system resulting in orthostatic tachycardia and hypotension, coldness of the extremities, episodes of sweating or profound pallor, sluggish pupils, bowel changes and micturition, possibly as a result of a lesion of the hypothalamus. There are usually cephalgias, characterized in mild cases with retro-orbital and occipital headaches in the early stages of the disease process. In severe cases, the illness may debut with a severe incapacitating pancephalic pain that may persist for months. In addition, cervical and upper thoracic vertebrae pain, often with causalgia, is regularly encountered. If the illness persists for a period of more than one year, there is an alarming tendency for the disease process to become chronic.
Chronic illness represents an extension of the features of the acute illness.
The patient should always be seen and investigated by a qualified physician to rule out these illnesses. Patients who persist in their illness for more than six months should be re-examined at least every six months and tested yearly, since some illnesses may declare themselves in an erratic and cyclical manner. Previously active children shun physical activity. Those with previously good academic levels may start to fail their grades. Since development of this illness often occurs in grade 8, children changing school systems are out of view of the teachers who know them well.