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Updated: Jul 14, 2025

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
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Episodic Migraine and POTS.

Bridget Mueller1

  • 1Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1139, New York, NY, 10029, USA. bridget.mueller@mssm.edu.

Current Pain and Headache Reports
|October 7, 2023
PubMed
Summary
This summary is machine-generated.

Migraine patients show altered stress responses, with potential to worsen postural orthostatic tachycardia syndrome (POTS) pathology. Treatments for migraine and POTS should address underlying causes.

Keywords:
Autonomic nervous systemDysautonomiaHPA axisPOTS

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Area of Science:

  • Neurology
  • Endocrinology
  • Cardiology

Background:

  • Migraine is common in patients with postural orthostatic tachycardia syndrome (POTS).
  • Stress response systems are implicated in both migraine and POTS.
  • Understanding these systems is crucial for managing comorbid conditions.

Purpose of the Study:

  • To review and interpret studies on stress response systems in migraine patients.
  • To examine the relevance of these systems to POTS pathology.
  • To review key components of the stress response network.

Main Methods:

  • Literature review of studies on autonomic nervous system and hypothalamic-pituitary-adrenal axis in migraine.
  • Analysis of evidence linking stress response activation to vascular dysfunction and central sensitization.
  • Synthesis of findings regarding the impact on POTS.

Main Results:

  • Migraine patients exhibit interictal sympathetic hypofunction and ictal sympathetic hyperfunction.
  • The hypothalamic-pituitary-adrenal axis shows elevated responsivity in migraine.
  • Stress response activation during migraine may worsen vascular dysfunction, central sensitization, and POTS pathology.

Conclusions:

  • Activation of stress response systems in migraine can exacerbate POTS.
  • Treatment strategies for comorbid migraine and POTS should consider POTS etiology.
  • Further research into the interplay between these conditions is warranted.