When someone walks into our clinic with chronic neck pain and recurring headaches, our first thought isn’t usually a cardiovascular dysregulation disorder. We often consider posture, movement dysfunction, spinal loading, or stress. But occasionally, the true culprit is more elusive—and one of those less common, yet important, considerations is POTS, or Postural Orthostatic Tachycardia Syndrome.
Although POTS is not something we treat every day at Central Ohio Spine and Joint, it’s important to recognize that it can influence musculoskeletal symptoms, especially in patients whose pain doesn’t follow typical patterns or respond to standard care.
Let’s take a closer look at how this condition works and why it could be the missing link in understanding your persistent neck pain and headaches.
What is POTS?
POTS is a form of dysautonomia, a disorder of the autonomic nervous system. This part of your nervous system regulates involuntary functions like heart rate, blood pressure, and digestion. In POTS, the body fails to maintain blood pressure and heart rate effectively when moving from lying down to standing.
Key Diagnostic Criteria:
- Heart rate increases by 30 beats per minute (or more) within 10 minutes of standing.
- Occurs without a significant drop in blood pressure (which rules out orthostatic hypotension).
- Symptoms persist for more than 6 months.
- More common in women aged 15–50.
POTS can be triggered by viral infections, surgery, pregnancy, or other stressors on the body. It often overlaps with chronic fatigue syndrome, fibromyalgia, and Ehlers-Danlos syndrome, creating a diagnostic and therapeutic challenge.
Common Symptoms of POTS
- Lightheadedness or dizziness upon standing
- Fatigue, especially after minimal exertion
- Brain fog and difficulty concentrating
- Rapid heart rate
- Nausea or gastrointestinal discomfort
- Sweating abnormalities
- Sleep disturbances
But here’s where it gets interesting for clinicians like us: many patients with POTS also report musculoskeletal complaints—particularly neck pain, tension-type headaches, and even jaw discomfort.
How POTS Can Cause Neck Pain and Headaches
1. Chronic Muscle Tension from Autonomic Stress
When your nervous system is in a constant state of “alert,” muscles tend to stay tight. In patients with POTS, the sympathetic nervous system often goes into overdrive, leading to increased baseline muscle tone, particularly in the cervical spine, upper traps, and suboccipital muscles. These areas are prone to tension-related pain and trigger points.
2. Deconditioning and Poor Postural Endurance
Many POTS patients avoid standing or upright activity due to dizziness and fatigue. This leads to deconditioning, including weakness in postural muscles like the deep neck flexors and scapular stabilizers. Over time, these imbalances cause forward head posture, rounded shoulders, and an increased load on the cervical spine—all of which contribute to neck pain and cervicogenic headaches.
3. Blood Flow Dysregulation and Neural Sensitivity
The same dysfunction that causes tachycardia and dizziness in POTS also affects cerebral and muscular perfusion. Poor circulation can increase the sensitivity of cervical and cranial nerves, creating a fertile ground for migraines, cervicogenic headaches, and myofascial pain.
Recognizing Red Flags in a MSK Patient
If you’re dealing with chronic neck pain and headaches that don’t improve with typical treatment like chiropractic care, dry needling, or corrective exercise, it may be time to ask deeper questions:
- Do symptoms worsen when standing or after long periods of sitting?
- Do they experience frequent lightheadedness or racing heart when changing positions?
- Is there a history of viral illness, COVID-19, or autoimmune disease?
- Do they report unusual fatigue, sweating changes, or GI symptoms?
In these cases, autonomic dysfunction should be on your radar, and a referral to a cardiologist or neurologist familiar with POTS is appropriate.
Conservative Treatment Options for MSK Pain in POTS Patients
While we may not be treating POTS itself, understanding it helps us modify and personalize care:
1. Gentle, Graded Exercise
Many patients benefit from a horizontal exercise protocol (like recumbent biking, swimming, or supine strength training) to gradually improve tolerance to upright activity. Programs like CHOP’s POTS protocol and the Levine protocol are often used to build autonomic resilience.
2. Postural Retraining
Correcting head and neck posture with deep neck flexor strengthening, scapular stability work, and thoracic mobility exercises can significantly reduce the musculoskeletal load. This helps offset the deconditioning common in POTS patients.
3. Manual Therapy and Dry Needling
Targeted manual therapy and dry needling can help reduce muscle tension in the upper traps, levator scapulae, and suboccipitals. However, care must be taken not to overstimulate the autonomic system. Keep treatments low intensity and monitor responses closely.
4. Breathwork and Parasympathetic Activation
Box breathing, diaphragmatic breathing, and HRV-based biofeedback are excellent tools to down-regulate sympathetic tone and reduce muscle tension.
Final Thoughts
POTS is not a condition most musculoskeletal clinics treat directly—but if you’re someone with recurrent neck pain, chronic tension-type headaches, and unexplained fatigue or dizziness, it’s worth considering whether autonomic dysregulation could be a contributing factor.
At Central Ohio Spine and Joint, we pride ourselves on digging deeper when standard approaches fall short. If you feel like your symptoms have been dismissed or you haven’t gotten the full picture, we’re here to help investigate.
Don’t settle for a generic plan. Get care tailored to your body.
👉 Schedule your evaluation today and let’s figure it out—together.
Recent Comments