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.
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References
Shaw BH, Stiles LE, Bourne K, Green EA, Shibao CA, Okamoto LE, et al. The face of postural tachycardia syndrome—insights from a large cross-sectional online community-based survey. J Intern Med. 2019;286(4):438–48.
Deb A, Morgenshtern K, Culbertson CJ, Wang LB, Hohler AD. A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome. Proc (Bayl Univ Med Cent). 2015;28(2):157–9.
Boris JR, Bernadzikowski T. Demographics of a large paediatric postural orthostatic tachycardia syndrome program. Cardiol Young. 2018;28(5):668–74.
Durham J, McDonald C, Hutchinson L, Newton JL. Painful temporomandibular disorders are common in patients with postural orthostatic tachycardia syndrome and impact significantly upon quality of life. J Oral Facial Pain Headache. 2015;29(2):152–7.
Mokri B, Low PA. Orthostatic headaches without CSF leak in postural tachycardia syndrome. Neurology. 2003;61(7):980–2.
Brinth L, Pors K, Spahic JM, Sutton R, Fedorowski A, Mehlsen J. Postural Orthostatic Tachycardia Syndrome (POTS) in Denmark: increasingly recognized or new epidemic? Auton Neurosci. 2018;213:92–5.
Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clinic Proc. 2007;82(3):308–13.
Heyer GL, Fedak EM, LeGros AL. Symptoms predictive of postural tachycardia syndrome (POTS) in the adolescent headache patient. Headache. 2013;53(6):947–53.
Ojha A, Chelimsky TC, Chelimsky G. Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr. 2011;158(1):20–3.
Thieben MJ, Sandroni P, Sletten DM, Bernrud-Larson LM, Shen W, Low PA. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc. 2007;82(3):308–13.
Jiawei L, Qingyou Z, Hongjun H, Hongfang J, Junbao D. Clinical features and management of postural tachycardia syndrome in children: a single-center experience. Chin Med J. 2014;127(21):3684–9.
Li J, Zhang Q, Hao H, Jin H, Du J. Clinical features and management of postural tachycardia syndrome in children: a single-center experience. Chin Med J (Engl). 2014;127(21):3684–9.
Robertson D, Kincaid DW, Haile V, Robertson RM. The head and neck discomfort of autonomic failure: an unrecognized aetiology of headache. Clin Auton Res. 1994;4(3):99–103.
Khurana RK, Eisenberg L. Orthostatic and non-orthostatic headache in postural tachycardia syndrome. Cephalalgia. 2011;31(4):409–15.
Miglis MG. Migraine and autonomic dysfunction: which is the horse and which is the jockey? Curr Pain Headache Rep. 2018;22(3):19.
Thijs RD, Kruit MC, van Buchem MA, Ferrari MD, Launer LJ, van Dijk JG. Syncope in migraine: the population-based CAMERA study. Neurology. 2006;66(7):1034–7.
Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646–57.
Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clinic Proc. 2012;87(12):1214–25.
Graf N, Fernandes Santos AM, Ulrich CT, Fung C, Raabe A, Beck J, et al. Clinical symptoms and results of autonomic function testing overlap in spontaneous intracranial hypotension and postural tachycardia syndrome. Cephalalgia Rep. 2018;1:1–6.
Kavi L, Gammage MD, Grubb BP, Karabin BL. Postural tachycardia syndrome: multiple symptoms, but easily missed. Br J Gen Pract. 2012;62(599):286–7.
Liu FC, Fuh JL, Wang YF, Wang SJ. Connective tissue disorders in patients with spontaneous intracranial hypotension. Cephalalgia. 2011;31(6):691–5.
Schievink WI, Maya MM, Louy C, Moser FG, Sloninsky L. Spontaneous intracranial hypotension in childhood and adolescence. J Pediatr. 2013;163(2):504–10.
Kranz PG, Gray L, Amrhein TJ. Spontaneous intracranial hypotension: 10 myths and misperceptions. Headache. 2018;58(7):948–59.
Kranz PG, Gray L, Malinzak MD, Amrhein TJ. Spontaneous intracranial hypotension: pathogenesis, diagnosis, and treatment. Neuroimaging Clin N Am. 2019;29(4):581–94.
Mokri B. Spontaneous intracranial hypotension. Continuum. 2015;21(4 Headache):1086–108.
Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. A framework for the classification of joint hypermobility and related conditions. Am J Med Genet C Semin Med Genet. 2017;175(1):148–57.
Castori M, Morlino S, Ghibellini G, Celletti C, Camerota F, Grammatico P. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. Am J Med Genet C Semin Med Genet. 2015;169C(1):84–96.
Dijkstra PU, Kropmans TJ, Stegenga B. The association between generalized joint hypermobility and temporomandibular joint disorders: a systematic review. J Dent Res. 2002;81(3):158–63.
Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38:1–211.
Blake P, Burstein R. Emerging evidence of occipital nerve compression in unremitting head and neck pain. J Headache Pain. 2019;20(1):76.
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D’Antona, L., Matharu, M. (2021). Headache in Postural Tachycardia Syndrome. In: Gall, N., Kavi, L., Lobo, M.D. (eds) Postural Tachycardia Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-54165-1_13
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DOI: https://doi.org/10.1007/978-3-030-54165-1_13
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