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Review
. 2022 Jul;62(7):792-800.
doi: 10.1111/head.14365. Epub 2022 Jul 19.

Postural orthostatic tachycardia syndrome and migraine: A narrative review

Bridget R Mueller  1 , Jessica Robinson-Papp  2
Affiliations
Review

Postural orthostatic tachycardia syndrome and migraine: A narrative review

Bridget R Mueller et al. Headache. 2022 Jul.

Abstract

Objective: In this narrative review, we summarize experimental and clinical evidence demonstrating mechanistic connections between POTS and migraine.

Background: Migraine is the most common comorbidity in patients with POTS, a heterogenous disorder of the autonomic nervous system characterized by orthostatic intolerance and positional tachycardia. POTS is a debilitating illness with few effective treatments. We aim for this narrative review to increase awareness of the mechanistic connections between POTS and migraine providing foundational information that optimizes clinical care and advances the development of pathophysiologic-based treatments.

Methods: We used the PubMed and Medline databases in November 2021 to perform a literature review and searched for the following keywords: "postural orthostatic tachycardia syndrome," "POTS," "autonomic nervous system," AND "migraine," "headache."

Results: The high prevalence of migraine in patients with POTS may be explained by common pathologic mechanisms. There is evidence that dysregulation of the sympathetic nervous system, alterations in central and peripheral hemodynamics, and central sensitization increase vulnerability to both POTS and migraine. Non-pharmacologic and pharmacologic treatments that target these shared mechanisms may provide significant benefit for the patient with POTS and migraine.

Conclusions: Identification of common affected pathways may provide important insight that advances our understanding and treatment of both migraine and POTS.

Keywords: autonomic nervous system; headache; sympathetic nervous system.

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References

REFERENCES

    1. Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - part 1. Auton Neurosci. 2021;235:102828.
    1. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. 1993;43(1):132-137.
    1. Physician Patient Interaction in Postural Orthostatic Tachycardia Syndrome. Dysautonomia International; 2021.
    1. Öner T, Guven B, Tavli V, Mese T, Yilmazer MM, Demirpence S. Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics. 2014;133(1):e138-e142.
    1. Stiles LE, Cinnamon J, Balan I. The patient perspective: what postural orthostatic tachycardia syndrome patients want physicians to know. Auton Neurosci. 2018;215:121-125.

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