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Fluctuating illness
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===Possible causes of fluctations=== Tate et al. (2018) states fluctuations in ME/CFS symptoms may result from neuroinflammation: "'Inflammatory marker' studies, including magnetic resonance imaging (MRI) pre- and post-exercise studies, support the concept that symptom severities likely 'wax and wane' in tandem with fluctuating levels of chronic [[neuroinflammation]] in the brains and [[Central nervous system|CNS]] of ME/CFS patients, and this is an important feature of this paradigm."<ref name="Mackay2018">{{Cite journal | last = Mackay | first = Angus | author-link = Angus Mackay | last2 = Tate | first2 = Warren P. | authorlink2 = Warren Tate | date = Dec 2018 | title = A compromised paraventricular nucleus within a dysfunctional hypothalamus: A novel neuroinflammatory paradigm for ME/CFS| url = https://journals.sagepub.com/doi/abs/10.1177/2058738418812342|journal=International Journal of Immunopathology and Pharmacology|volume=|issue= | pages = |doi=10.1177/2058738418812342|quote=|via=}}</ref> {{See also|Neuroinflammation}} People with ME/CFS generally have a blunted rise in heart rate as activity increases in intensity during (as shown during [[cardiopulmonary exercise testing]]), which worsens with [[post-exertional malaise]]. This suggests cardiac autonomic dysregulation, which may cause fluctuating symptoms.<ref name="Davenport2021"/> A [[Boom and bust activity cycle|"boom and bust"]] cycle of overactivity (on better days) then less far activity (due to [[crash]]ing caused by [[post-exertional malaise]]) also leads to large fluctuations in symptoms. Activity [[pacing]] is often suggested to address this.<ref name="Davenport2021"/> {{See also|Boom and bust activity cycle}} {{See also|Pacing}}
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