Postural Tachycardia Syndrome Is Common Among Migraineurs

Beta-blockers can lower the heart rate, but may perpetuate or fail to improve fatigue. Serotonin and norepinephrine reuptake inhibitors such as venlafaxine may enhance sympathetic neurotransmission, but “I haven’t been able to determine any rhyme or reason for how or why patients respond [to these drugs],” said Dr. Goodman.

If a patient’s condition does not improve after treatment, it may respond to drugs that are not indicated for orthostatic intolerance. Ivabradine, which does not have FDA approval, is similar to domperidone and “an outstanding medication at lowering heart rate … but it doesn’t affect blood pressure,” said Dr. Goodman. Medications for attention deficit disorder, such as a combination of amphetamine and dextroamphetamine, also may stabilize blood pressure and improve cognition.

Complete Recovery May Be Elusive
Most patients with POTS will improve, but many will continue to have chronic symptoms. “Patients with the best prognosis will be those who were well, had a preceding infection, and then developed symptoms of orthostatic intolerance,” said Dr. Goodman. Patients who report having had symptoms throughout their lives are a challenge. Although these people may have abnormalities that cannot be resolved completely, “that doesn’t mean we can’t try to help them,” Dr. Goodman concluded.

—Erik Greb