Synergistic but separable sensory changes in postural tachycardia syndrome and chronic migraine
Open accessAbstract
Purpose Up to 90% of patients with postural tachycardia syndrome (PoTS) report headaches, and comorbid migraine headaches are common. Given this, pathophysiological interaction is possible, which may reveal key aspects of disease expression and treatment opportunities. We hypothesized that PoTS subjects-both with and without migraine-would show features of central sensitization, including allodynia and photophobia. Methods Eighty participants were evaluated, including 30 PoTS, 30 chronic migraine (CM), and 20 non-headache healthy controls (NH), using tilt table testing, psychophysical assessment of sensory sensitivity thresholds, and an online questionnaire to assess measures of headache burden and associated symptoms. Clinical characteristics and sensory thresholds were compared between disease groups and controls, as well as in a subgroup analysis within the PoTS group, based on headache phenotype. Results Sensory sensitivity thresholds were significantly lower and symptom scores were higher in both the PoTS and CM groups compared to controls. However, the patterns of expression differed between PoTS and CM, with pain threshold reductions in the forearm only of PoTS subjects (non-trigeminal sensory sensitization), compared to both periorbital and forearm sites in CM. Unexpectedly, light sensitivity thresholds were significantly lower in PoTS than in both CM and NH. Conclusions These findings reveal an underappreciated aspect of disease burden in PoTS, and suggest network sensitization similar to, but separable from, that of migraine. The presence of both photophobia and allodynia in PoTS is reflective of exteroceptive rather than strictly interoceptive disruption, and expands our fundamental understanding of the disorder.
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Orthostatic intolerance symptoms contributed most to differences between POTS and other groups, followed by light sensitivity, pupillomotor function, vasomotor domains and fatigue.
“Orthostatic intolerance symptoms contributed most to differences between POTS and other groups, followed by light sensitivity (Cortez et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Cortez et al., 2020
The Results sections on Autonomic and Sensory Symptoms and Sensory Thresholds (pages unavailable) report that orthostatic symptoms were the only autonomic domain significantly different between PoTS and chronic migraine, and that light sensitivity was more common in PoTS. They do not rank these features by their contribution to group differences or establish the claimed ordering of pupillomotor function, vasomotor domains, and fatigue. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPeople with POTS had a higher heart rate increment on head-up tilt (HUT) than healthy controls, people with CFS, chronic migraine, and autonomic failure/neuropathy.
“People with POTS had a higher heart rate increment on head-up tilt (HUT) than healthy controls, people with CFS”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Cortez et al., 2020
The Results (Clinical characteristics; page not provided) report a significantly higher heart-rate increment in the PoTS group than in healthy non-headache controls and the chronic migraine group. The Methods (Participants; page not provided) identify no CFS or autonomic failure/neuropathy comparison group, so the claimed comparisons with those groups are not supported by this paper. (LLM, conf=0.90)
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- Authors
- Cortez, M. M., Millsap, L., & Brennan, K. C.
- Affiliations
- University of Utah (US)
- Corresponding author
- Cortez, Melissa M.
- Venue
- Clinical Autonomic Research
- Published
- 2020-11-10
- Volume
- 31
- Issue
- 2
- Pages
- 263-271
- ISSN
- 0959-9851 (ISSN-L)
- 1619-1560
- PMC
- PMC8043970
- OpenAlex
- W3104805232
- Cited by
- 11
- References
- 64
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Autonomic Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (NIMHD LRP)
- American Autonomic Society (Lundbeck Fellowship Grant)
- American Academy of Neurology (Clinical Research Scholarship)
- Fairclough Endowment
- National Institute of Neurological Disorders and Stroke (R01 NS 102978, R01 NS 104742)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- postural orthostatic tachycardia syndrome, chronic migraine, central sensitization, allodynia, photophobia, photosensitivity, pain threshold, headache burden, autonomic dysfunction, migraine comorbidity
- MeSH terms
- Forearm, Headache, Humans, Migraine Disorders, Postural Orthostatic Tachycardia Syndrome
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