Postural Orthostatic Tachycardia Syndrome (POTS) & Migraine
It’s estimated that 28% of people with POTS have migraine.Brent Goodman, MD | Mayo Clinic StudyYou may be wondering what the connection between Postural Orthostatic Tachycardia Syndrome (POTS) and (vestibular) migraine is. The answer is quite simple: in some people, POTS can present as a “symptom” of their chronic migraines. It happened to me! I was first diagnosed with Postural Orthostatic Tachycardia Syndrome at the Cleveland Clinic back in May of 2014, but insisted that my primary symptoms of dizziness, difficulty walking, and visual motion sensitivity came from another source. In December of 2014, I finally found my answer– the primary factor precipitating my symptoms was vestibular migraine. But as the Otolaryngologist who diagnosed me explained, migraine can actually “cause” POTS to occur in some patients.
The link between migraine and autonomic nervous system dysfunction is undeniable. In fact, it’s estimated that 28% of people with POTS have migraine (“Migraineurs…” 2015). For me, treating my migraine through lifestyle changes, dietary changes, medicines, and supplements greatly reduced my POTS symptoms.
If you have been diagnosed with a migraine disorder and also experience rapid heart beat, dizziness, fainting, exercise intolerance, lightheadedness upon standing, then this page may be of interest to you!
What is Postural Orthostatic Tachycardia Syndrome (POTS)?
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder in which patients experience symptoms of orthostatic intolerance– rapid heartbeat, lightheadedness, fainting, and dizziness– upon standing. These symptoms are typically exacerbated by standing up from a lying down or sitting position, and alleviated when the person lays flat. How does this happen?
When a person without POTS stands up…
Gravity pulls blood from throughout their body into their lower extremities. To compensate for the sudden loss of blood in the heart and brain, their heart begins to beat faster and stronger, increasing their blood pressure. In addition, the blood vessels in the lower half of their body constrict, forcing the blood back up into the heart and head.
When a person with POTS stands up…
The process is the same as above, except the blood vessels in their lower body fail to constrict, so blood pools in their lower extremities. Without enough blood in their upper body, the brain senses a lack of blood, and in response, their heart beats faster and faster in an attempt to re-distribute blood throughout the body.
Like migraine, POTS is most common in women ages 15-50. Women represent 80% of the POTS population, though many men are also affected by this disorder (“NINDS…” 2015).
The Symptoms of POTS:
Here is a list of the of POTS, ranked from most common to least common, per Low et al. 2009:
Lightheadedness, dizziness, palpitations, presyncope (feeling faint, weak, lightheaded, with blurred vision), heat intolerance, exercise intolerance, feeling of weakness, fatigue, nausea, tremors, sleep disturbance, shortness of breath, migraine, chest pain, fasting intolerance, bloating, diarrhea, myofascial pain, exacerbation by menses, constipation, abdominal pain, excessive sweating, bladder problems, vomiting, loss of sweating, pupillary symptoms, and neuropathic type pain.
If you have migraine, you probably notice some pretty significant overlap between POTS and migraine symptoms. For me, as someone with both POTS and vestibular migraine, it’s hard to tell where the POTS symptoms end and the migraine symptoms begin. What I can absolutely attribute to POTS, though, is the rapid heart beat that increases dramatically upon sustained standing.
The At-Home Test for POTS:
Unlike migraine, there is an objective test to determine whether or not someone has POTS. This test can first be done informally at home to determine if someone is a candidate for the POTS diagnosis, and then confirmed in a clinical setting:
- Step 1: Lay down on a completely flat surface, like a bed, for at least 5 minutes and try to stay as still as possible.
- Step 2: While laying down, measure your heart rate by multiplying the number of times your heart beats in 20 seconds by three. If you need more instructions on how to take your pulse, you can read this how-to article. Write this number down– it’s your heart rate measured in beats per minute (bpm).
- Step 3: Now, stand up carefully, doing your best to transition from laying down to standing up without taking a break to sit in between. If you’re concerned that you may fall over or pass out, have someone present to assist you. Once you’re standing, try your best to stay still– don’t lean on anything or flex your leg muscles.
- Step 4: Watch the clock; after you’ve been standing for exactly 2 minutes, take your pulse again.
- Step 5: Remain standing and continue to take your pulse every 2 minutes until 10 minutes have passed.
- Step 6: Subtract your laying down heart rate from your maximum standing heart rate (max #bpm standing – #bpm laying = ??).
If your maximum heart rate while standing exceeds your laying down heart rate by more than 30bpm, then you may be a candidate for the POTS diagnosis. (Heart rate must increase by more than 40bpm if you’re 12-19 years old.) If at any point while standing your heart rate exceeded 120 bpm, you may also qualify. If you think you may have POTS, the next step is to follow up with a cardiologist.
An alternative to this 6-step method is to use the free Stand Test for POTS App available on the iTunes store to perform an at-home test for POTS!
The Official Way to Diagnose POTS – Tilt Table Test:
A doctor will review the results of your tilt table test, and can often diagnose you with POTS if your heart rate rises by at least 30 bpm as the tilt increases.
My experience with the tilt table test: When I had to do the tilt table test, I was absolutely terrified– one of my biggest fears was passing out, and the idea of subjecting myself to a test that could cause this reaction felt impossible. But, I did the test anyways. There was no way I was turning down an opportunity to be diagnosed with POTS, and to subsequently receive treatment for this debilitating disorder. Yes, the test was unpleasant– imagine all of your POTS and migraine-related symptoms occurring simultaneously over a 45-minute period– but it was worth it. As the test ended and the table returned back to laying flat, I felt more and more like myself again. And finally, I was able to receive treatment for this disorder. Unfortunately, some of the treatments for POTS are migraine triggers, so I ended up making myself a bit worse before I got better, but having the diagnosis helped tremendously.
Treatments for POTS:
Like migraine, there are a variety of treatments for POTS including medicinal, lifestyle, dietary, and behavioral treatments.
Something else your doctor could prescribe as a treatment for POTS are compression stockings. Compression stockings made an enormous difference for me from day 1.
Sources | Literature Cited:
Carew S, Cooke J, O’Connor M, Donnelly T, Costelloe A, Sheehy C, and Lyons D. 2009. What is the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome? Europace. 11(5): 635-637.
“Migraineurs Frequently Experience POTS.” National Headache Foundation. N.p., 04 May 2015. Web. 11 June 2016.
“NINDS Postural Tachycardia Syndrome Information Page.” National Institute of Neurological Disorders and Stroke. N.p., 2 Dec. 2015. Web. 11 June 2016.