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Updated: May 21, 2026
14:09
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Coat-hanger ache in orthostatic hypotension
1Department of Medicine, Union Memorial Hospital, 201 East University Parkway, Baltimore, MD 21218, USA. lyn.camire@medstar.net
Cephalalgia : an International Journal of Headache
|June 20, 2012
Summary
Coat-hanger ache (CHA) is common in orthostatic hypotension (OH) patients during daily life but rarely occurs during head-up tilt (HUT) tests. This suggests OH and CHA may not be directly linked, indicating a complex underlying cause.
Area of Science:
- Autonomic Nervous System Disorders
- Cardiovascular Physiology
- Symptomology in Neurological Conditions
Background:
- Orthostatic hypotension (OH) patients frequently report coat-hanger ache (CHA).
- Laboratory investigation of CHA during head-up tilt (HUT) is lacking.
- This study aimed to compare CHA occurrence in OH patients during daily activities versus HUT.
Purpose of the Study:
- To compare the frequency and clinical characteristics of coat-hanger ache (CHA) in orthostatic hypotension (OH) patients.
- To investigate the precipitation of CHA during head-up tilt (HUT) in comparison to daily activities.
Main Methods:
- Retrospective review of prospectively collected data from 22 dysautonomic patients.
- Assessment of autonomic functions (cardiovagal, adrenergic, sudomotor) using standard tests.
- Recording and analysis of CHA occurrence and features during daily activities and HUT.
Main Results:
- All patients exhibited severe autonomic dysfunction (OH, cardiovagal, sudomotor impairment).
- 59% of patients reported CHA during daily activities, with symptom relief upon recumbency.
- Only 18% of patients developed CHA during HUT, with variable clinical features.
Conclusions:
- CHA is frequently reported by OH patients in daily life but infrequently during HUT.
- The low incidence of CHA during HUT challenges a direct association with OH.
- The pathophysiology of CHA in OH patients appears complex and variable.
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