For me, it varies so much. Lately, it's been hot and crazy humid in Minnesota and that type of weather is a huge trigger for me. I've been struggling with nausea, heartburn, lightheadedness, tinnitus, occasional dizziness, fatigue, tachycardia, palpitations, feeling of weakness, and difficulty exercising. In contrast to this, when all the stars align (I.e. cool weather, enough sleep, average stress level, etc.) I have days when I feel almost "normal". Hope this helps.