Chronic Dizziness? You Might Need To Ask Your Doctor To Test For This
If you've been dealing with chronic dizziness and can't seem to get answers, you're not alone—and you're not imagining it. Standing up too fast, waiting in line, and even just existing on certain days can leave some people feeling lightheaded, foggy, and drained. Often, these symptoms are dismissed as anxiety, dehydration, or "just stress."
But there's a condition many doctors don't routinely test for: postural orthostatic tachycardia syndrome, or POTS. And according to new research1, it might be worth advocating for testing if chronic dizziness has been part of your life.
What is POTS?
POTS is a form of dysautonomia (a dysfunction of the autonomic nervous system). The autonomic nervous system controls involuntary functions like heart rate, blood pressure, and digestion, which means POTS can affect all of these areas.
According to the National Institute of Neurological Disorders and Stroke (NINDS), POTS is characterized by an excessive increase in heart rate upon standing. The diagnostic criteria for adults is a heart rate increase of 30 beats per minute or more within 10 minutes of standing (or during a tilt table test), without a significant drop in blood pressure. For adolescents ages 12-19, the threshold is 40 bpm or more.
Common symptoms of POTS include:
- Orthostatic dizziness (dizziness upon standing or when standing for long periods)
- Lightheadedness
- Fatigue
- "Brain fog" or difficulty concentrating
- Blurred vision
- Heart palpitations
- Exercise intolerance
- Nausea
POTS predominantly affects women—five times as often as men—and often begins in adolescence, though it can develop at any age. Many people first notice symptoms during puberty, after a viral illness (such as COVID-19), after surgery, or during periods of significant hormonal change.
Why POTS is often missed
Here's the frustrating reality: when someone goes to a neurologist for chronic dizziness, providers are typically looking for vestibular causes, issues with the balance system in the inner ear. These can include vestibular migraines, or a condition called persistent postural-perceptual dizziness (PPPD), which is chronic dizziness that worsens when upright due to an inner ear issue. These are all valid diagnoses, but identifying which one is at play matters because treatment plans vary.
Dysautonomia, including POTS, is often not included in standard neurology training. The researchers describe POTS as "a missing piece in the puzzle of chronic dizziness," one that's frequently overlooked because it simply isn't on many providers' radar.
What makes this even more complicated is that POTS symptoms can look a lot like anxiety. Racing heart, lightheadedness, and difficulty breathing are overlapping symptoms, and the two diagnoses are often not mutually exclusive. POTS can affect anxiety, and anxiety can affect POTS. Many people with POTS are initially told their symptoms are purely psychological, which can delay proper diagnosis by years.
The overlap between POTS, vestibular migraine, & PPPD
One important thing to understand: having one diagnosis doesn't rule out another. Someone can have vestibular migraine and POTS at the same time, and treating only one may leave them still struggling.
PPPD frequently coexists with POTS. If someone has been diagnosed with PPPD or vestibular migraine but isn't getting full relief from treatment, it may be worth asking a provider about autonomic testing.
The key takeaway: a comprehensive evaluation should consider all possibilities, not just the most common ones.
How POTS is diagnosed
The good news is that POTS can be diagnosed with relatively simple tests:
10-minute stand test (active standing test): The patient lies down for a period of time, then stands up while heart rate and blood pressure are monitored for 10 minutes. If heart rate increases by 30 bpm or more (40 bpm for adolescents) without a significant blood pressure drop, this suggests POTS.
Tilt table test: This is considered the gold standard. The patient is strapped to a table that tilts from lying down to an upright position while heart rate and blood pressure are continuously monitored.
Those who suspect POTS can ask their doctor specifically for autonomic testing. Not all providers are familiar with these tests, so it may be necessary to seek out a cardiologist, neurologist, or autonomic specialist who has experience with dysautonomia.
Treatment options for POTS
While there's no cure for POTS, symptoms can vary widely and can often be managed effectively with a combination of lifestyle modifications, management of comorbid conditions, and medications.
Lifestyle modifications:
- Increasing salt, electrolyte, and fluid intake (under medical guidance) to help maintain blood volume
- Wearing compression garments on the legs and abdomen
- Gradual, reclined exercise programs (like recumbent biking or swimming)
- Avoiding prolonged standing and rising slowly from lying or sitting positions
- Managing stress
How to advocate for proper testing
If chronic dizziness has been affecting quality of life and POTS testing hasn't been done, here's how to advocate for a thorough evaluation:
Questions to ask your doctor:
- "Could my symptoms be related to dysautonomia or POTS?"
- "Can we do an active standing test or tilt table test?"
- "Would a referral to an autonomic specialist be appropriate?"
Keep a symptom diary: Track when dizziness occurs, what was happening at the time, body position (standing, sitting, lying down), and any other symptoms. This information can help providers see patterns.
Request specific tests: Don't be afraid to ask directly for autonomic testing. If a provider isn't familiar with POTS, they may not think to offer it.
Seek a second opinion: If symptoms are being dismissed or not taken seriously, it's okay to find another provider. Organizations like Dysautonomia International maintain lists of physicians who specialize in autonomic disorders.
The takeaway
If chronic dizziness has remained unexplained, POTS is worth exploring. It's a real, diagnosable condition with options for management—not anxiety, not "just stress," and not something to be dismissed.
New research highlights dysautonomia as a missing piece in the chronic dizziness puzzle. Everyone deserves a thorough evaluation that considers all possibilities, and advocating for the right testing is an important step toward finding answers.
Knowledge is power. And sometimes, finding the right diagnosis is the first step toward finally feeling better.