POTS and Migraines: Why You Cannot Treat Them Separately
POTS and Migraines: Why You Cannot Treat Them Separately
Her husband would find her on the bathroom floor. On the kitchen floor.
For years, Kathy from Vermont was passing out from POTS while also managing 25 migraines every single month.
She had tried every medication available. Then she had a severe allergic reaction to her last option and there was nothing left to try.
Nobody had ever told her that the two conditions were connected.
That they were, in fact, the same fire expressing itself in two different ways. That the reason nothing was fully working was because nobody had ever looked at the whole picture.
That is the conversation we need to have about POTS and migraines. And it is one that most doctors are not having with you.
Between 41% and 96% of women with POTS also experience chronic migraine. That is not a coincidence.
What Is POTS and Why Does It Take So Long to Diagnose?
POTS stands for Postural Orthostatic Tachycardia Syndrome.
It is a disorder of the autonomic nervous system, the part of your nervous system that controls automatic functions like heart rate, blood pressure, and digestion.
In a healthy body, when you stand up, your autonomic nervous system makes a quick adjustment to keep blood circulating properly throughout your body and brain.
In a body with POTS, that adjustment does not happen correctly.
Your heart rate spikes by at least 30 beats per minute within 10 minutes of standing. Blood pools in your lower body instead of reaching your brain. And your nervous system, scrambling to compensate, goes into overdrive.
The symptoms that result include dizziness and lightheadedness when standing, heart pounding, extreme fatigue, brain fog, nausea, blurred vision, and in severe cases, passing out completely.
POTS predominantly affects women. And it is massively under diagnosed.
On average, it takes six years for a woman to receive a POTS diagnosis.
Six years of being told her symptoms are anxiety, stress, or just how she is.
If that sounds familiar, it should. Because the migraine journey looks almost identical.
What Conventional Medicine Offers for POTS and What It Misses
When a woman finally gets a POTS diagnosis, she is typically told to drink more water, add more salt to her diet, wear compression stockings, and begin a gradual exercise program. In moderate to severe cases, medications are added.
Here is something most POTS patients are never told: as of right now, there is not a single medication FDA approved specifically for POTS. Every drug prescribed for POTS is being used off-label, meaning it was developed for something else and is being repurposed because there are limited options.
The most common medications include beta-blockers like propranolol to lower heart rate, midodrine to raise blood pressure, and fludrocortisone, a synthetic steroid that tells the kidneys to retain more sodium to increase blood volume.
That last one deserves special attention. Fludrocortisone works by helping the body hold onto sodium. But in the process, it depletes potassium and magnesium.
So a woman with POTS and migraines who is placed on fludrocortisone is simultaneously being given something that makes her mineral picture worse.
Her migraine pattern gets worse alongside it. And nobody in any of her specialist appointments is putting those two facts together.
The Three Reasons POTS and Migraines Keep Showing Up Together
Research published in the journal Headache identified three shared mechanisms that explain why POTS and migraine co-occur at such high rates.
Sympathetic Nervous System Dysregulation
Both POTS and migraine involve an autonomic nervous system that is stuck in overdrive. A nervous system that cannot shift out of fight or flight. In POTS, this shows up as the uncontrolled heart rate spike when you stand.
In migraine, it shows up as a nervous system so sensitized that ordinary stimuli, light, sound, smell, a slight change in barometric pressure, are enough to trigger a full attack.
Hemodynamic Instability
Blood flow and blood volume regulation are disrupted in both conditions. In POTS, blood pools in the lower body when you stand because the vascular system cannot maintain proper tone. In migraine, blood vessel dilation and constriction are central to what triggers the attack.
These are not two separate problems. They are the same underlying vascular instability expressing itself through two different symptoms.
Central Sensitization
Both POTS and migraine involve a central nervous system that has become hypersensitive to stimuli. A system that has been overwhelmed for so long that it now overreacts to things that should be ordinary.
This is why POTS symptoms are often triggered by things as simple as standing up, getting too warm, or eating a large meal. And it is the same mechanism that explains why migraine triggers seem to multiply over time.
Three shared mechanisms. One root cause.
The Inflammation Network Behind Both Conditions
In the Freedom From Migraines Method, we work with a concept called the Inflammation Overload Loop. It is the framework that explains why chronic migraines keep coming back no matter what you try. And it is also the framework that explains POTS.
Your body has an inflammatory threshold. Think of it like a bucket. When everything filling that bucket, stress, hormones, gut dysfunction, poor sleep, mineral imbalances, toxin exposures, rises above a certain level, your nervous system fires an alarm signal.
In the case of migraines, that alarm is the migraine attack. In the case of POTS, that alarm is the dysregulated autonomic response.
When the inflammation network is overloaded, it does not express itself in just one way. It expresses itself through every vulnerable system in your body.
For many women, that means migraines and POTS at the same time. Because the same fire is driving both.
Why Minerals Are the Starting Point
In Phase 1 of the Freedom From Migraines Method®, one of the six key areas we address is Electrolyte Symmetry.
This is where the POTS connection becomes concrete.
Your autonomic nervous system, the exact system that is dysregulated in POTS, runs on minerals.
Sodium, potassium, magnesium, and calcium are the electrical signaling system of your body. They regulate how your cells fire, your heart rate, your blood vessel tone, and your nerve transmission.
When those minerals are out of balance, and in most women with both migraines and POTS they are significantly out of balance, the autonomic nervous system cannot regulate properly.
Blood volume becomes unstable. Heart rate becomes erratic. Blood vessels cannot maintain tone. The nervous system cannot shift out of fight or flight.
Most women with both conditions are already mineral depleted before anyone looks at it.
Chronic stress burns through magnesium. Poor sleep depletes it further. Gut dysfunction, which is extremely common in women with both POTS and migraines, means minerals are not being absorbed properly even when they eat well. And if they are on fludrocortisone, that is actively making the depletion worse.
Using the CHECK Method, a key component of The Freedom From Migraines Method®, we identify each woman's specific mineral picture and address it in the right sequence for her body.
Not a generic supplement recommendation. Her actual imbalances, in the right order.
What I consistently see when we do this: the POTS symptoms start to calm down alongside the migraines. Not because we targeted the POTS. Because we addressed the root that was driving both.
Kathy's Story
Kathy is from Vermont. When I met her, she was running a dairy farm and a market garden business with her husband. For at least 15 years before she found The Freedom From Migraines Method® [FFMM], she was having 25 migraines every single month.
She also had POTS. Severe POTS.
Her husband would find her unconscious on the bathroom floor. On the kitchen floor. She was passing out from the dysautonomia while simultaneously trying to manage daily migraines.
She had tried triptans, over the counter medications, and monthly migraine injections. Then she had a severe allergic reaction to the injections. Other health conditions limited what medications she could safely take. There were no options left.
"I truly was at the point of not wanting to continue on the journey of life if the massive head pain I had every day was going to be a part of it." - Kathy S., Vermont
When Kathy addressed the root through FFMM, starting with the mineral foundation in Phase 1, things began to shift. The migraines decreased in frequency, intensity, and duration. And the POTS symptoms shifted alongside them.
Her husband noticed early on. Days were going by without a migraine. She was no longer passing out. She was present at family events, actually laughing and engaging instead of sitting there pretending to be okay. She went to her grandchild's birthday party and actually smiled.
She now runs her dairy farm and gardens for ten months out of the year. She gets in the car on a whim. She puts events on her calendar and expects to show up.
"Getting a migraine these days is shocking to me."
Kathy did not get better because we treated her POTS separately.
She got better because we addressed what was driving everything. The POTS responded because it was always part of the same picture.
Another Freedom From Migraines Method member, Barbie, said,
“I know for sure that getting the right amount of salt for my body made a huge difference in my POTS. My doctors had mentioned salt before, but looking back, it was never enough to really move the needle.
Since going through the Freedom From Migraines Method®, I now understand how to properly balance my main electrolytes, including salt, and it has completely changed things for me. My POTS symptoms are now very mild compared to what they used to be, and honestly, I rarely even think about it anymore.”
Why Treating POTS and Migraines in Separate Offices Keeps You Stuck
When you have both POTS and migraines, you are likely seeing multiple specialists.
A cardiologist for the POTS.
A neurologist for the migraines.
Maybe a gynecologist, a gastroenterologist, a rheumatologist.
Each one is looking at their piece, prescribing for their piece, managing their piece.
None of them can see the whole picture because the whole picture does not live in any one of their offices. It lives in your body. And your body is one system.
The result is often multiple medications, each targeting a different symptom of the same underlying fire, none of them addressing the fire itself. And sometimes actively making each other worse.
This is not a criticism of specialists. They are working within a system designed to treat parts. But for women whose bodies are expressing one problem through multiple systems, that approach is never going to be enough.
What to Do If This Sounds Like You
They are connected. You are not just unlucky to have both. They share a root. Addressing that root is the path forward.
Your minerals matter. The autonomic nervous system runs on sodium, potassium, magnesium, and calcium. If those are depleted, nothing else can regulate properly.
This is usually the first place to look and often the first place where women start to feel a difference.
Advocate for yourself. If you have not been evaluated for POTS, ask your doctor specifically about an orthostatic heart rate test. If your heart rate rises by 30 or more beats per minute when you stand, that is information worth having.
The sequence matters. This is why Phase 1 of the Freedom From Migraines Method® focuses on building the foundation before anything else.
When you do it in the right order, both conditions respond.
Ready to Understand What Is Actually Driving Your Symptoms?
A complimentary Migraine Breakthrough® Assessment is a 45-minute conversation where we look at your full history, your specific symptom picture, and map out what is actually happening in your body.
Most women leave the assessment saying they have more clarity about what is driving their migraines and their POTS than they have gotten from years of specialist appointments.
If you have been treated separately for both and neither has fully resolved, this is your next step.
Book your complimentary Migraine Breakthrough® Assessment here
Debbie Waidl is a Migraine Freedom Expert and Certified Health Coach and the founder of the Freedom From Migraines Method®. She spent ten years living with daily migraines before finding and addressing the root cause. She now helps women do the same.
Resources
📥 FREE DOWNLOAD:Toxic Migraine Triggers Guide
Discover the hidden inflammatory triggers keeping your migraines alive.
📚 Learn More:The Freedom From Migraines Method®
Discover how to heal chronic migraines without relying on medications, injections, or surgery.
Related Articles
Debbie Waidl is a Migraine Freedom Expert and founder of the Freedom From Migraines Method®. She works with women in perimenopause and menopause to identify and address the root causes of chronic migraines so they can stop managing their pain and start living their lives.
Disclaimer: This article is for educational purposes only and is not medical advice. Always consult with your healthcare provider before making decisions about medical procedures or treatments. Debbie Waidl and In The Balance Health Coaching LLC are not responsible for any decisions made based on information in this article.
