Hi @mitribri. I am on my 5th yr and experience this same thing. As so many, providers have no specific cause and hard to describe so unless they have personally had it finding helpful techniques to manage has worked for me. I did have one reference to clothes hanger neck that resonated yet our own individual reactions may not fit that? Talking when feeling even a little worse or with other activity like writing or others in room brings this on for me🙃. I have put a heating pad at the top of pillow I lean against in upright position that I can adjust the temp to respond to severity and calm the reaction. May I suggest you research histamine reactions if new to you as that also really helped to reduce my episodes and I have a epi pen..Hope this helped and quickest healing to you🌈