Migraine in Postural Orthostatic Tachycardia Syndrome (POTS) (P3.126)

Objective: Headache characteristics were prospectively studied in 41 consecutive patients with postural orthostatic tachycardia syndrome (POTS). Background: POTS, the most prevalent form of orthostatic intolerance, is a heterogeneous disorder that is associated with a number of symptoms, including headache. The prevalence and clinical features of headache and how it relates to clinical signs and symptoms in POTS patients have not been widely reported. Design/Methods: Forty-one consecutive new patients undergoing an evaluation for POTS were included in this study. All patients underwent a clinical interview including evaluation of headache, completed a composite autonomic symptom score (COMPASS) questionnaire, illness intrusiveness scale questionnaire, autonomic testing, and routine laboratory studies. Results: A total of 41 patients were included in the study; 36 were female, mean age 25, with a mean autonomic symptom duration of 4.6 years. All but 2 patients reported a history of headache, 73% of patients reported a headache onset prior to age 20, and 12% reported headache onset in conjunction with autonomic symptoms. Chronic migraine (CM) was diagnosed in 25 (61%), episodic migraine (EM) in 12 (29%), new persistent daily headache in 1 patient, and orthostatic headache in 1 patient. When compared with EM, those with CM had higher COMPASS scores, higher scores on illness intrusiveness scale, lower supine norepinephrine values, and were more likely to have abnormal blood pressure profile with the Valsalva maneuver on autonomic testing. Conclusions: Headache is present in nearly all patients with POTS. CM was present in nearly 2/3’s of the patients in this cohort and was associated with more severe autonomic symptoms, greater perception of symptom disability, lower supine norepinephrine levels, and greater likelihood of blood pressure abnormality with the Valsalva maneuver, relative to patients with EM. Disclosure: Dr. VanderPluym has nothing to disclose. Dr. Hoffman-Snyder has nothing to disclose. Dr. Khoury has nothing to disclose. Dr. Goodman has nothing to disclose.