Objective:

To evaluate whether patients with postural orthostatic tachycardia syndrome (POTS) with history of headache have a greater disease burden than those without headaches.

Background:

Headache is a common and often debilitating symptom in patients with POTS. Given absence of disease-specific outcomes and the multi-dimensional nature of symptom burden, assessment of POTS often includes symptom-specific questionnaires to assess the scope and severity of accompanying symptoms.

Design/Methods:

A retrospective chart review was done of patients < 20 years old seen at the University of Utah Autonomic Clinic and clinically diagnosed with POTS; patients were subdivided on the basis of headache history (inclusive of undiagnosed recurrent headache, migraine, and positional/orthostatic headache). Results of the Fatigue Severity Scale (FSS), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Composite Autonomic Symptom Score (COMPASS-31) assessments performed at the time of initial evaluation were recorded. Statistical comparisons were made using unpaired t-test; p-values <0.05 were considered significant.

Results:

58 patients aged 9-20 years were included (from 2015-2021), with a median age of 17.9 years. Of these, 44 (76%) had a documented history of recurrent headaches. The most notable difference was in GAD-7 scores, where the average score was 3.6 points higher in patients with headache (11.5 vs 7.9, p = 0.04). For all other symptom scales, including all subdomains of the COMPASS-31, scores were higher in patients with a documented history of headache; however, these differences were not statistically significant.

Conclusions:

The presence of headache is associated with higher scores on GAD-7 assessment in patients with POTS. Patients with headache also demonstrated higher average scores on FSS, PHQ-9, and COMPASS-31 assessments, however these were not statistically significant. This finding highlights the relationship between recurrent headache and anxiety symptoms and may also suggest a negative impact of headache on symptom severity across multiple domains in patients with POTS.