What could chronically high unconjugated bilirubin mean in someone with orthostatic syncope, headaches, fatigue, neuropathic pain and a history lyme?

Probably nothing: You probably have Gilbert's non-disease and some unrelated health problems. I trust your physician is aware of this and has run a reticulocyte count to be sure you are not hemolyzing. Your other symptoms suggest a stressful living situation but there are a host of other entities to rule out -- have you been checked for porphyria? Best wishes.