POTS + Migraine: Why These Two Conditions Often Show Up Together
If you’ve ever dealt with migraine attacks and symptoms like lightheadedness, racing heart, shakiness, exhaustion, or feeling awful every time you go up the stairs… there may be something further going on!
One condition that can cause these symptoms and often overlaps with migraine is POTS.
POTS, or Postural Orthostatic Tachycardia Syndrome, is a type of dysautonomia - meaning the autonomic nervous system isn’t functioning normally. This dysfunction affects important processes in the body like blood flow, heart rate, and other automatic body functions properly.
Since many symptoms of POTS and other forms of dysautonomia can overlap with migraine, this can lead to delays in proper diagnosis and treatment for quite some time. So let’s dig into it!
What POTS Feels Like
POTS is often described as an issue maintaining proper blood flow when changing positions - in particular when going from laying down to sitting, or sitting to standing.
When this happens, your body has to work way harder to compensate for the reduced blood flow to important areas like the chest and head.
That can feel like:
Racing heart
Lightheadedness
Dizziness
Intense fatigue
Shakiness
Shortness of breath
Exercise intolerance
Brain fog
GI symptoms
Feeling exhausted after doing normal daily activities
And if you’re nodding your head vigorously reading that list of symptoms like “okay yes, that’s me!”, you’re not alone!
Why POTS and Migraine Overlap So Often
Research shows POTS is significantly more common in people with migraine, and over 90% of people with POTS experience migraine attacks.
And that overlap makes sense when you look at the bigger picture!
Both conditions involve:
Nervous system dysregulation
Blood vessel changes
Blood flow issues
Sensory sensitivity
GI dysfunction
Stress response dysfunction
Exercise intolerance
Fatigue and cognitive symptoms (like brain fog)
By the way, this is a big reason why migraine feels like so much more than “just a headache - because a migraine attack involves systems throughout the entire body, not just inside your head.
The POTS Problem: Lack of Awareness & Proper Diagnosis
It’s easy to write common POTS symptoms off as “just another part of migraine”, especially when they overlap so closely with actual migraine symptoms.
There’s also a lack of awareness around dysautonomia in general, so many people who go to the doctor concerned about these symptoms are told:
It’s just anxiety
You’re just dehydrated
You need to exercise more
We just need to manage your migraine better
What’s frustrating is you can end up feeling like you’re being lazy, dramatic, overly-sensitive, or somehow just making up these symptoms … when in reality your body is genuinely struggling to regulate basic physiologic processes.
Managing Migraine + POTS Requires a Whole-Body Approach
There’s no one-size-fits-all strategy here, but common areas that can help support both migraine and POTS include:
Hydration + Sodium
Many people with POTS benefit from increasing fluids and electrolytes - especially sodium - to help support more stable blood volume.
This often works best when people “front-load” fluids before they even get out of bed, and then continue with steady hydration throughout the rest of the day.
Some people with POTS benefit from increasing their daily sodium levels to as much as 10,000mg - which is a LOT of salt!
Be sure to work with your healthcare team before trying something like this to avoid complications.
Blood Sugar Stability
Large blood sugar swings can be a trigger for both POTS and migraine symptoms, so supporting good blood sugar control can help.
This can look like:
Eating more consistently
Avoiding long stretches without food
Building balanced meals with protein, carbs, fats, and fiber
Being mindful of high-carb meals that worsen symptoms
Meal Structure
A lot of people with POTS feel worse after large meals - this is because digestion itself requires blood flow and nervous system resources.
Smaller, more frequent meals can work better since they put less strain on your body overall.
Pacing + Energy Management
This is a huuuge one!
Many people with migraine and dysautonomia get stuck in a cycle of:
Pushing through symptoms
Overdoing it on a “good day”
Crashing
… Rinse and repeat
Learning how to pace yourself and work with your body instead of against it can make a major difference over time.
Nervous System Support
Stress doesn’t cause POTS or migraine - but a chronically overloaded nervous system can absolutely make symptoms worse and lower your threshold.
Things like:
Consistent sleep schedules
Gentle movement
Creating boundaries
Managing sensory inputs to avoid overload
Allow yourself recovery time
…all matter more than you might realize!
If You Suspect POTS or Dysautonomia…
It’s definitely worth bringing up with a qualified healthcare provider, especially if you notice:
Symptoms worsening when upright
Significant heart rate increase when changing positions
Frequent dizziness or lightheadedness
Exercise intolerance
Heat intolerance
Feeling faint or shaky regularly
Migraine management can become a lot easier when you understand the full picture of what your body is dealing with!
Takeaways
POTS and other forms of dysautonomia are manageable, especially when you have support from healthcare providers who understand how interconnected these systems are.
In particular, having a cardiologist, neurologist, physical therapist, and registered dietitian on your team who understand dysautonomia can be a game changer!
And importantly: management usually works best when the goal isn’t “perfect symptom control overnight,” but gradually building resilience and improving your overall threshold over time.
Show yourself some grace and know going into this journey that it will take time, and that’s okay!!
New to The Migraine Dietitian?
Download the free 12-page Migraine 101 Guide for a clear, no-BS guide to how migraine actually works — including attack phases, triggers, and the underlying factors that influence your threshold.
Looking for a more strategic approach to migraine care?
Raise Your Threshold is a structured migraine care program for people who want more than random tips and trigger lists.
It’s designed to help you understand what’s actually driving your migraine patterns so you can build resilience over time using a whole-body approach.
