If you have postural orthostatic tachycardia syndrome (POTS), there’s a good chance you have migraine too. Multiple studies have connected POTS with chronic migraine at rates estimated from 41% to 96% of people with the condition.
Both migraine and POTS can keep you from your daily activities and lead to pain and fatigue. Keep reading to learn about migraine symptoms and how doctors treat migraine when you have POTS.
What does a POTS flare-up feel like?
POTS is a disorder that leads to orthostatic intolerance. This means you feel lightheaded or faint when standing. But POTS causes your heart rate to increase by more than
While orthostatic intolerance is the main symptom, there are others. These include:
- passing out
- problems sleeping
- chest pain
- shortness of breath
These symptoms usually get better when you lie down.
Doctors don’t know exactly why people with POTS also experience migraine. They do know that women are more likely to experience both conditions.
According to a 2020 review, females with POTS experience migraine at higher rates than females who don’t have POTS.
POTS can also affect how well your nervous system works. Migraine is an unusual adaptation that affects how nervous system signals are transmitted. Both conditions can signal underlying changes to how the nervous system is “communicating.”
Sometimes it’s hard to know if your headache is a migraine or another headache type. Doctors use a mnemonic called POUND to aid in diagnosing migraine headaches:
- Pulsing quality
- One-day duration (but can last up to 72 hours)
- Unilateral (one-sided)
- Nausea or vomiting
- Disabling intensity
If your headache has four to five of these features, it’s likely migraine. But some migraine episodes may have two or three of these symptoms. Talk with your doctor if you experience frequent headaches.
There aren’t many clinical studies or guidelines that lay out the best treatments for migraine when you have POTS. For this reason, doctors will usually treat migraine attacks the same as they would for other people with migraine.
Still, it’s important to tell your doctor that you have POTS. As we’ll discuss later, some medications doctors commonly prescribe to treat migraine could affect your POTS symptoms.
This doesn’t mean that you can’t take migraine-relieving medications. But it does mean you should be aware of potential side effects.
Treating migraine usually involves avoiding triggers and taking medications to relieve symptoms. However, some medications doctors commonly prescribe to
For example, doctors may prescribe tricyclic antidepressants (TCAs) like amitriptyline. But TCAs can cause side effects that worsen POTS symptoms, like dry mouth, fatigue, and constipation. A doctor may prescribe nortriptyline, a TCA that has fewer of these side effects instead.
Another medication prescribed to prevent migraine is venlafaxine. This medication can sometimes worsen rapid heart rate or heart palpitations in people with migraine.
Topiramate is another medication used to prevent migraine. It can cause increased sensations of brain fog and slowed thinking in those with POTS.
Migraine preventive medications that POTS patients may tolerate well include:
- beta-blockers like metoprolol, propranolol, or atenolol
- botulinum toxin (BOTOX) injections
- magnesium supplements
According to a 2018 review, those with POTS who have migraine headaches related to their menstrual cycle may benefit from a short-term course of naproxen or triptan medications, like zolmitriptan.
It’s important to know that pain-relieving medications like opioids aren’t usually effective for migraine headaches. You can use over-the-counter pain relievers for migraine (like acetaminophen). But if you find you’re using them daily or weekly, talk with your doctor about other options.
Migraine episodes tend to have specific triggers. These include:
- eating or drinking certain foods, like wine, aspartame, or foods with other chemical preservatives
- unusual visual stimulation, like flashing lights
- weather changes
If you’re able to identify your specific triggers, avoiding them may help you prevent an episode. Getting enough sleep can also help.
Exercise can often help reduce the incidence of migraine headaches, but may be difficult if you have POTS. If you can tolerate physical activity, regular exercise may help you feel better.
Can migraine be a sign of POTS?
POTS is a difficult condition for doctors to diagnose. It takes, on average, 6 years before a person gets a reliable diagnosis. POTS commonly affects young females and often occurs alongside other medical conditions, like chronic fatigue syndrome and fibromyalgia.
While those with POTS experience migraine headaches at higher rates, most people will first notice orthostatic intolerance. Their symptoms may date back to their teenage years and include episodes of feeling lightheaded or even passing out when standing. These symptoms will usually get worse over time.
POTS is a condition that often causes headaches, including migraine headaches as part of its symptoms. Treating and preventing migraine headaches can be difficult. Avoiding triggers can help.
If you experience frequent headaches and have POTS, talk with your doctor about treatment options to help you experience fewer headache days.