POTS and fibromyalgia: Link, diagnosis, and more

Can you have both POTS and fibromyalgia? Absolutelyresearch shows around oneinfive people with Postural Orthostatic Tachycardia Syndrome (POTS) also meet the criteria for fibromyalgia, and they share a surprising number of symptoms.

How are they diagnosed and treated? POTS is confirmed with a tilttable or standing test, while fibromyalgia is diagnosed by the ACR 2010 criteria after other conditions are ruled out. Both conditions respond best to a blend of medication, gentle graded exercise, fluidsalt loading, and mindbody strategies such as CBT.

Why They Overlap

Neurological & autonomic overlap

Both disorders sit at the crossroads of the nervous system. POTS is an autonomic conditionyour body's "autopilot" that controls heart rate and blood pressure goes a bit haywire when you stand. Fibromyalgia, on the other hand, is considered a central sensitization disorder, meaning the brain amplifies pain signals. The two share brainfog, fatigue, and even migrainetype headaches, suggesting a shared neuroimmune pathway.MedicalNewsToday explains the connection.

Demographic patterns

More than 90% of diagnosed cases are women, typically in their late teens to early thirties. Hormonal fluctuations and connectivetissue differences are thought to play a role, which is why you'll see a lot of overlap in femalepredominant clinics.

Common triggers & comorbidities

Many patients notice symptoms flare after a viral illnessthink COVID19, mono, or a gut infection. This "postviral" trigger is a hallmark of both POTS and fibromyalgia. Other frequent companions include hypermobile EhlersDanlos syndrome, mastcell activation, and chronic fatigue syndrome.

Realworld example

Take Maya, a 29yearold teacher. After a bout of flu, she began feeling dizzy on her way up the stairs and suffered aching muscles that never seemed to quit. A tilttable test showed a 38bpm heartrate risePOTS confirmed. Her pain map covered her shoulders, hips, and knees, meeting the ACR criteria for fibromyalgia. Within months of a combined care planbetablockers, hydration, and a gentle recumbent bike routineher symptoms softened enough for her to return to the classroom.

Symptoms to Watch

POTSspecific clues

Look for a rapid heartrate jump of at least 30bpm (or >120bpm total) when you stand, accompanied by lightheadedness, visual "shades," or fainting. Blood pressure usually stays stable, which helps differentiate it from other forms of orthostatic hypotension.

Fibromyalgiaspecific clues

Widespread aches lasting three months or more, tender points on the neck, shoulders, hips, and knees, plus nonrestorative sleep and that dreaded "fibrofog"a hazy mental state that makes even simple tasks feel taxing.

Overlapping symptoms (quick reference)

Symptom	POTS	Fibromyalgia	Why it overlaps
Fatigue	Yes (postural)	Yes (persistent)	Autonomic dysregulation reduces cerebral perfusion; pain disrupts sleep.
Brain fog	Yes (orthostatic)	Yes (central sensitization)	Both lower oxygen delivery and heightened neuroinflammation.
Headache / migraine	Common	Common	Vascular and neuroimmune pathways intersect.
GI upset (nausea, IBS)	Yes	Yes	Autonomic gut innervation is affected in both.

How to Diagnose

POTS diagnostic pathway

First, a thorough history: when do symptoms start? How long do they last? Then comes the standing or tilttable test. If your heart rate jumps 30bpm (or >120bpm total) within 10minutes of standing while blood pressure stays steady, you've met the classic POTS criteria. Some clinics also check norepinephrine levels or autoimmune markers to see if an underlying process is contributing.

Fibromyalgia diagnostic pathway

The ACR 2010 (and its 2016 update) uses two numbers: the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. A WPI of 7 or more plus an SS score of 5 or higher clinches the diagnosisprovided other rheumatologic or neurologic diseases have been ruled out with labs.

Expert tip

Dr. David Harris, a neurologist at the EhlersDanlos Clinic, advises, "Never rely on a single test. A multidisciplinary assessmentcardiology, rheumatology, physical therapygives the clearest picture, especially when POTS and fibromyalgia coexist."

Pitfalls & differentials

Conditions that can masquerade as POTS include inappropriate sinus tachycardia, anemia, hyperthyroidism, or even anxietyrelated heartrate spikes. For fibromyalgia, rule out rheumatoid arthritis, lupus, and thyroid disease before confirming the diagnosis.

Management Strategies

Pharmacologic options

Condition	Medication class	Typical agents	Goal
POTS	Volume expanders	Fludrocortisone, Midodrine	Increase blood volume, improve vascular tone
POTS	Heartrate control	blockers, Ivabradine	Reduce excessive tachycardia
Fibromyalgia	Antidepressants	Duloxetine, Amitriptyline	Modulate central pain perception
Fibromyalgia	Anticonvulsants	Pregabalin, Gabapentin	Ease neuropathictype pain
Both	NSAIDs (shortterm)	Ibuprofen, Naproxen	Provide temporary pain relief

Nonpharmacologic core

Fluid & salt loading. Aim for 23L of water daily plus about 3g of extra salt (think a teaspoon of sea salt in a glass of water). This bolsters blood volume and eases the upright heartrate surge.

Compression garments. Wearing 3040mmHg thighhigh stockings or a waisthigh compression shirt can prevent blood from pooling in the legs, which is a common trigger for POTS episodes.

Graded exercise. Start where you arerecumbent cycling, swimming, or even lyingdown yoga. Slowly progress to sitting, then standing activities. The PoTSUK program shows that a structured, lowimpact regimen can improve orthostatic tolerance in up to 70% of patients.

Cognitive Behavioral Therapy (CBT). Evidence from multiple studies indicates CBT reduces both pain intensity and anxiety in fibromyalgia, and it also helps people with POTS manage the stress that can aggravate symptoms.

Lifestyle quick wins

• Keep a simple symptom diarynote heart rate, posture, food, and stress levels.
• Avoid prolonged standing, hot showers, and excessive caffeine.
• Prioritize sleep hygiene: dark room, cool temperature, and a consistent bedtime.
• Connect with a communityonline forums or local support groups can provide emotional lifts and practical tips.

Patient story

James, a 42yearold accountant, found relief after joining an online "POTS + Fibro" group. He began drinking a "saltwater mix" each morning, wore compression socks, and followed a 10minute seated bike routine three times a week. Within three months, his dizziness dropped from daily to a few times a month, and his chronic aches softened enough for him to return to weekend hiking.

Special Considerations

Postviral onset

The pandemic taught us a harsh lesson: many longCOVID patients develop newonset POTS and fibromyalgia. Autoantibody generation and lingering inflammation appear to tip the autonomic balance, making vigilant monitoring crucial after any serious infection.

Hypermobile EhlersDanlos link

If you've ever been told you're "doublejointed," you might belong to the "PoTS Plus" categoryhypermobile EDS often coexists with both conditions. Joint laxity can affect blood vessel tone, further destabilizing blood pressure when upright.

Hormonal influences

Estrogen modulates autonomic function, which partly explains why women experience higher rates of both POTS and fibromyalgia. Some patients notice symptom spikes around menstrual periods or menopause, prompting clinicians to discuss hormonebalancing strategies.

Safety & redflags

If you ever experience sudden chest pain, severe shortness of breath, or a syncopal event with injury, seek emergency care. These can signal cardiac or neurologic emergencies that require immediate attention.

Conclusion

Seeing the connection between POTS and fibromyalgia can feel like a puzzle finally fitting together. Both share autonomic quirks, paincentralization, and often a postviral trigger, which is why a dualfocused treatment plan works best. By combining smart medication choices, diligent fluidsalt strategies, gentle graded exercise, and mindbody tools like CBT, many people regain enough stability to enjoy everyday moments again.

Remember, you don't have to navigate this alone. Find a specialist who understands both the heartrate spikes and the widespread aches, track your symptoms, and lean on supportive communities. If you found this guide helpful, consider downloading our printable symptomtracker or sharing your own story in the commentsyour experience could be the spark someone else needs.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.