Do you frequently get light headed or dizzy when you stand up? Do you feel your heartbeat speed up out of nowhere or after minimal exercise? Do you tire out very easily? Perhaps you wind up feeling full after eating only a small amount? Or maybe you get cold very easily or you have trouble regulating your body temperature…
These are only a handful of the frequently undiagnosed, or misdiagnosed, condition knowns as POTS: postural orthostasis and tachycardia syndrome. In POTS, people have problems regulating their autonomic nervous system – the part of the body that controls the automatic functions of the body (digestion, blood pressure or pulse control, temperature regulation, among others). This problem frequently occurs with people either after a viral illness, or sometimes after a ‘shock to the system’ like pregnancy, trauma, or surgery. This is often felt to be an auto-immune condition (where the body’s immune system winds up attacking itself). It is often misdiagnosed as fibromyalgia, anxiety, irritable bowel syndrome or a whole host of other conditions. Unfortunately, a common symptom of POTS is migraine.
Once proper diagnosis is made, however, there are many treatment strategies available. Some are related to lifestyle as simple as increasing fluid intake and salt thus preventing or at least helping the drops in blood pressure. Similarly, wearing compression stockings can be an effective component of treatment. Eating smaller meals that are lower in carbohydrates (starches, sugars) may also help. Sleep (another automatic function) should be optimized, as many people with POTS describe sleep disturbance. Exercise should be started to avoid additional muscle weakness. However, as many people have trouble with this, it should be started slowly and built up gradually. Avoiding alcohol may also be quite useful.
Medications may be tried to help control blood pressure fluctuations, improve sleep, and GI function (constipation, diarrhea). A few of the medications used are as follows:
- Benzodiazepines (examples: Valium, Klonopin, Xanax)
- Beta blockers (example: propranolol)
- Fludrocortisone (Florinef)
- Pyridostigmine (Mestinon)
- Selective Serotonin Reuptake Inhibitors (SSRIs. Examples: Prozac, Lexapro, Paxil, Zoloft)
Other medications should be avoided. As this list is quite long, if you suspect that you have this condition, please speak to your doctor about this.
Many of you may have realized that many of the same treatments tried for POTS are the same as those tried in migraine. Indeed, it is estimated that 30% of people with POTS may have migraine headaches.
Most importantly, don’t give up hope. The journey to diagnose this and to find a physician knowledgeable in its treatment may be long and frustrating. However, as best you can, try to maintain a good outlook. New treatments are coming out and as this problem is becoming more recognized, more resources become available.