POTS and Dysautonomia: Supportive Neck Care in Redmond, WA
Honest information about POTS, and gentle NUCCA upper cervical care for the neck pain and headaches that often come with it.
Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia, a problem with the part of the nervous system that controls heart rate, blood pressure and other automatic functions. When people with POTS stand up, their heart races and they may feel lightheaded, foggy, shaky or exhausted.
We want to be upfront: NUCCA chiropractic does not treat POTS or dysautonomia. POTS is diagnosed and managed by a cardiologist, neurologist or autonomic specialist. Many people with POTS also have hypermobility, a concussion history, neck pain or headaches, and that is where gentle NUCCA care may help.
What Is POTS?
International medical societies define POTS as:
- A sustained heart rate increase of at least 30 beats per minute within 10 minutes of standing (at least 40 in teens), without a significant drop in blood pressure
- Frequent symptoms when upright that improve quickly when lying down
- Symptoms lasting at least 3 months
- No other condition, such as dehydration, anemia or a thyroid problem, that better explains the fast heart rate
POTS most often affects young women, frequently starting in the teen years or early adulthood. It can begin after a viral illness, a concussion, pregnancy or surgery.
01 · POTS and Hypermobility
POTS commonly occurs alongside hypermobile EDS. See our Hypermobility / EDS page.
02 · POTS After Concussion
Physical trauma, including concussion, is a recognized trigger. See our Post-Concussion page.
03 · Related Conditions
People with POTS may also have migraine, mast cell activation syndrome (MCAS) or chronic fatigue syndrome.
Common Symptoms
- Lightheadedness or near-fainting when standing
- A racing or pounding heart on standing
- Fatigue and exercise intolerance
- Brain fog and trouble concentrating
- Shakiness, weakness or blurred vision when upright
- Headaches
- Nausea and digestive problems
- Poor sleep
- Neck and shoulder pain ("coat-hanger" pain across the upper back and neck when upright)
Seek Medical Care Right Away For:
- Call 911 for chest pain, fainting with an injury, fainting during exercise, or a fast heart rate with shortness of breath that doesn't settle when you lie down
- Call 911 for sudden weakness or numbness on one side of the body, facial droop or slurred speech
- See your doctor promptly for new or worsening fainting, or if you haven't been evaluated for a racing heart
What Causes POTS?
The cause is not fully understood and likely differs from person to person. Researchers have linked POTS to:
- Low blood volume
- Blood pooling in the legs and abdomen when standing
- Damage to small nerves that control blood vessels
- An overactive stress (adrenaline) response
- Immune-related factors, often after a viral infection
- Deconditioning after illness or bed rest
- Connective tissue differences in hypermobility, which may make blood vessels stretch more
Where the Neck Fits In
The neck does not cause POTS, and correcting neck alignment does not fix the autonomic nervous system. But many people with POTS live with neck problems that add to their symptom load:
- Coat-hanger pain in the neck and shoulders when upright
- Neck-related headaches layered on top of migraine
- Neck injury from the concussion or whiplash that triggered their POTS
- Upper neck strain related to hypermobility
These are the areas where gentle upper cervical care may help.
Where NUCCA Care Fits, and Where It Doesn't
NUCCA (National Upper Cervical Chiropractic Association) care is a precise, low-force chiropractic approach focused on the alignment of the head and upper neck. Here is an honest look at its role:
NUCCA Care Does Not
- Treat or cure POTS or dysautonomia
- "Reset" the autonomic or vagus nerve
- Change heart rate, blood volume or blood pressure regulation
- Replace fluids, salt, compression, exercise programs or medications recommended by your doctor
- Treat MCAS, chronic fatigue or digestive symptoms
NUCCA Care May Help
- Ease neck and shoulder pain
- Ease neck-related headaches
- Support recovery from a neck injury that came with concussion or whiplash
- Offer gentle care for hypermobile necks
No Twisting
Your neck is never rotated or pushed to end range.
No Cracking
No thrust and no "pop." Just light, controlled hand contact.
Lying Down
Corrections are done while you lie on your side, a position many POTS patients tolerate well.
Precision Imaging
Upper cervical x-rays measure the exact direction and amount of misalignment.
What to Expect
Free consultation: Every new patient starts with a free consultation with Dr. Schallmann to review your POTS diagnosis, your care team and your neck symptoms. If your main concerns aren't neck-related, we'll tell you honestly. The examination and x-rays are not part of the consultation. They are separate services with their own fees, and we'll explain all costs before anything is done.
Making visits easier: Let us know about your POTS when you book. You're welcome to bring water and salty snacks, sit or lie down whenever you need to, and wear your compression garments. Tell us right away if you feel lightheaded at any point.
Visits 1 and 2 (1 hour each): If you move forward, your first visit includes an examination and precision upper cervical x-rays. Your second visit reviews the findings and includes your first gentle NUCCA correction.
Tracking progress honestly: We track your neck pain and headaches. We don't expect NUCCA care to change your POTS symptoms, and we'll tell you honestly if it isn't helping your neck.
The Providers Who Lead POTS Care
Expert consensus statements from the National Institutes of Health and the Heart Rhythm Society describe POTS care that usually begins with education and non-medication approaches, managed by your medical team:
- Cardiologist, neurologist or autonomic specialist for diagnosis (often with a stand test or tilt-table test) and treatment planning
- Increased fluids and salt, as directed by your physician
- Compression garments for the legs and abdomen
- A gradual exercise program, often starting with recumbent exercise like rowing, recumbent biking or swimming, ideally guided by a physical therapist
- Medications prescribed by your physician to manage specific symptoms
- Specialists for related conditions, such as an allergist for MCAS or a geneticist for hypermobility
There are currently no FDA-approved medications specifically for POTS, so care is tailored to each person. We're glad to coordinate with your other providers and share findings with your permission.
When NUCCA May Not Be the Right Fit
- You haven't been medically evaluated for your racing heart or fainting
- You're hoping NUCCA will treat your POTS. It isn't designed to.
- You have no neck pain, neck-related headaches or neck injury
- You are currently fainting frequently or your POTS is not yet stable enough to travel safely to appointments
- You have any of the warning signs above
What the Research Shows
There are no clinical trials showing that NUCCA or any chiropractic care treats POTS. You may see claims online that upper cervical care "resets" the autonomic nervous system. We don't make that claim, because the evidence doesn't support it. The sources below describe how POTS is defined and managed.
Vernino S, et al. (2021)
Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting, Part 1.
Autonomic Neuroscience, 235:102828.
An NIH expert consensus describing how POTS is diagnosed and managed, noting its overlap with hypermobile EDS, MCAS and migraine, and that there are no FDA-approved medications for POTS.
Sheldon RS, et al. (2015)
2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
Heart Rhythm, 12(6):e41–e63.
An international consensus on diagnostic criteria and management of POTS, endorsed by cardiology and autonomic societies.
Research findings describe groups of patients, not guaranteed individual outcomes. Your evaluation will determine whether NUCCA care is appropriate for you.
Frequently Asked Questions
Can a chiropractor treat POTS?
No. POTS is a disorder of the autonomic nervous system managed by a cardiologist, neurologist or autonomic specialist. NUCCA care may help with neck pain and headaches that often come with POTS, but it does not treat POTS itself.
Does upper cervical care "reset" the vagus nerve?
We don't make that claim. There is no good evidence that upper cervical or other chiropractic care treats dysautonomia. We'd rather be honest about what NUCCA can and can't do.
Why does my neck hurt when I'm standing?
Many people with POTS get "coat-hanger" pain, an ache across the neck and shoulders when upright, likely related to reduced blood flow to those muscles. It usually eases when you lie down. Neck injuries and hypermobility can add to it.
Is NUCCA care safe if I have POTS?
NUCCA corrections are gentle, with no twisting or thrust, and are done while you lie on your side. Let us know about your POTS so we can make your visits comfortable, and tell us right away if you feel lightheaded.
I have POTS and EDS. Can you help?
POTS and hypermobile EDS often occur together. NUCCA care may help with neck pain and headaches related to hypermobility, while your medical team manages your POTS. See our Hypermobility / EDS page.
My POTS started after a concussion. Is my neck involved?
It may be. Concussions often injure the neck at the same time, which can cause neck pain, headaches and dizziness alongside POTS. Your medical team manages the POTS, and NUCCA care may help with the neck component. See our Post-Concussion Syndrome page.
Is the first consultation really free?
Yes. Every new patient starts with a free consultation. The examination and x-rays are not part of it. They are separate services with their own fees, and we'll explain all costs before anything is done.
Related Conditions
- Hypermobility / EDS
- Post-Concussion Syndrome
- Craniocervical Instability (CCI)
- Headaches
- Migraines
- Neck Pain
- Chiari Malformation
- Fibromyalgia
Living with POTS and Neck Pain?
If neck pain or headaches are adding to your POTS symptoms, a free consultation can help you decide whether gentle NUCCA care is worth adding alongside your medical team.
Dr. Justin Schallmann, DC, is NUCCA Part 2 Certified and one of about 300 doctors trained in NUCCA worldwide.