First of all, what is POTS? It stands for postural orthostatic tachycardia syndrome. More than 500,000 people in the US may have POTS. It affects women 5 times more often than men and is usually diagnosed in the early teens or 20s. It is thought to be caused by a virus that damages or triggers an autoimmune attack on the part of the nervous system that maintains orthostatic tolerance.

These patients have lightheadedness or fainting with standing. They are diagnosed by heart rate increasing by at least 30 beats per minute and being greater than 120 beats per minute within 10 minutes of standing as compared to heart rate with the patient seated or supine.

Now, a new study concluded that 28% of people with POTS have migraine, whereas the prevalence of migraine is 18% in the general population. Further, 46% of migraineurs have a lifetime risk of syncope (fainting). Why this is so is not known.

Treatment is to increase salt and fluid intake, to exercise regularly, and certain medications may help. Prognosis varies. Some patients have symptoms for many years. For more information, see Neurology Reviews, April 2015.

Jack Florin, MD

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