Headache in Postural Tachycardia Syndrome
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 fi
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troduction 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 [1–3]. 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
L. D’Antona · M. Matharu (*) Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital of Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK e-mail: [email protected]
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.
Prevalence of Headache in PoTS The prevalence of headache as a symptom of PoTS has been reported to be between 28 and 100% [7, 8]. This sizeable range could be attributed to the diverse designs of the different studies. A summary of the articles reporting data on the prevalence of the headache in PoTS is provided in Table 1. Since 2011, three single centre surveys and one international survey on the clinical presentation of PoTS have been published [1, 2, 8, 9]. Shaw et al. recently reported the results of an international online cross-sectional survey conducted involving a total of 4835 participants with a diagnosis of PoTS [1]. According to this study, headache was among the five most common symptoms of PoTS with a prevalence of
© Springer Nature Switzerland AG 2021 N. Gall et al. (eds.), Postural Tachycardia Syndrome, https://doi.org/10.1007/978-3-030-54165-1_13
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L. D’Antona and M. Matharu
Table 1 Prevalence of headache in patients with postural orthostatic tachycardia syndrome (POTS) reported in the literature Author (Year)
Population studied
Shaw et al. (2019) [1]
4835 patients diagnosed with International survey POTS
3797 patients (94%)
Deb et al. (2015) [2]
39 patients diagnosed with POT
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