Headache in Postural Tachycardia Syndrome

Abstract

Patients with postural tachycardia syndrome (PoTS) have been reported to suffer headaches in up to 94% of the cases [1]. Among the myriad of symptoms that PoTS patients can be affected by, headache is very prevalent and has been reported as one of the five most common symptoms in PoTS by various authors [1, 2, 3]. In a large international survey on 4835 patients with PoTS, Shaw et al. highlighted that the most common comorbidity in PoTS is migraine (40%) [1]. Moreover, PoTS has been found to overlap with other comorbidities typically characterised by head and facial pain such as spontaneous intracranial hypotension and temporomandibular dysfunction [4, 5]. Headache in PoTS has diverse characteristics and it can be either a manifestation of the orthostatic intolerance secondary to PoTS or due to other underlying primary and secondary forms of headache. On occasions, headaches with different aetiologies can manifest in the same patient. The presence of headache in a PoTS patient can therefore pose diagnostic and therapeutic challenges: How can we differentiate between headache secondary to PoTS and other causes of headache? What is the best treatment strategy to manage PoTS patients with headache? Despite the rapidly increasing number of PoTS cases reported in the literature [6], only a few authors have provided a detailed description of the headache characteristics in their case series. In this chapter we summarise the current evidence on headache in PoTS patients and aim to provide information useful for the differential diagnosis and management of patients with headache and PoTS.