Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently. Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides. Panic attacks typically include some of these signs or symptoms: Sense of impending doom or danger Fear of loss of control or death Rapid, pounding heart rate Sweating Trembling or shaking Shortness of breath or tightness in your throat Chills Hot flashes Nausea Abdominal cramping Chest pain Headache Dizziness, lightheadedness or faintness Numbness or tingling sensation Feeling of unreality or detachment