Postural orthostatic tachycardia syndrome (POTS) and fibromyalgia are both neurological conditions that sometimes occur together.

Even though POTS and fibromyalgia are distinctly different conditions, they have some similarities.

This article discusses the link between POTS and fibromyalgia, whether a person can have both, and symptoms of both. It will also cover diagnosis, management, and frequently asked questions.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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POTS is a condition where a person experiences a rapid heart rate and fainting or lightheadedness when they stand up after lying down.

Fibromyalgia is a chronic condition that makes a person more sensitive to pain. Other signs include trouble sleeping and fatigue.

These conditions also cause a range of other symptoms in addition to the most commonly recognized effects.

Both are neurological conditions

Doctors have historically classified POTS as an issue with the peripheral nervous system (the nerves beyond the brain and spinal cord), but newer research suggests it could also be a central nervous system (CNS) disorder.

The American Society of Anesthesiologists describes fibromyalgia as a disorder resulting from hypersensitivity and hyperactivity of the CNS.

Both primarily affect females

Doctors more commonly diagnose both POTS and fibromyalgia in females.

An estimated 85% of people with a POTS diagnosis are female. For fibromyalgia, the percentage of diagnoses in females is 59–90% across varying studies.

Both involve similar symptoms and associations

A 2017 study found that participants with fibromyalgia had more symptoms of orthostatic intolerance (OI) than controls. OI is a core feature of POTS.

“Orthostatic” refers to standing upright. OI refers to symptoms that occur when a person stands upright and stops when they lie down.

Another link between fibromyalgia and dysautonomia disorders like POTS is their shared association with joint hypermobility and connective tissue disorders such as Ehlers-Danlos syndrome.

Both have a link to COVID-19

These conditions can result from COVID-19 infection. Several possible mechanisms exist, and research suggests that an autoimmune response may play a role.

POTS and fibromyalgia are not new and have existed for decades, but there has been an increase in cases associated with COVID-19.

Post-COVID-19 POTS may involve autoantibody production toward autonomic nerve fibers.

An imbalance in inflammatory cytokines, proteins that help cells communicate, is one possible theory explaining fibromyalgia pain that follows viral infections such as COVID-19.

POTS causes a range of symptoms of varying types.

Orthostatic symptoms

Orthostatic intolerance (OI) signs include:

Cerebral symptoms

Cerebral symptoms include:

Other symptoms

A person may also experience:

Fibromyalgia causes more effects than simply pain.

Symptoms include:

Research indicates that people with fibromyalgia may have an increased sensitivity to pain because of alterations in the activity of neural pathways that transmit pain signals.

Doctors use several assessments to diagnose POTS, including:

Many heart conditions and endocrine disorders can cause a rapid heart rate, and diagnostic tests can identify heart rate patterns to differentiate POTS from these disorders.

Doctors can test a person’s blood for anti-gAChR antibodies to detect POTS with an autoimmune origin.

These antibodies are present in blood samples of some people with POTS, which can sometimes help distinguish this disorder from other conditions.

Fibromyalgia is a diagnosis of exclusion. This means doctors rule out other conditions with similar symptoms.

To diagnose fibromyalgia, a doctor assesses a person’s medical history and performs a physical exam to determine the extent and location of their pain.

Therapy, medication, and self-management strategies may help reduce symptoms of POTS and fibromyalgia.


Cognitive behavioral therapy (CBT) teaches people how their thoughts can lead to feelings and behaviors. In the case of fibromyalgia, CBT addresses thoughts about pain.

CBT can help people adjust to having a long-term illness such as POTS.


Medications that may help treat fibromyalgia pain include:

These medications modify nerve sensitivity, which helps reduce pain.

POTS medication therapy helps by:

  • increasing blood volume
  • narrowing blood vessels
  • reducing a fast resting heart rate
  • supporting synapse transmission
  • improving cardiovascular control

Self-management strategies

Self-management strategies for POTS and fibromyalgia include:

  • exercise, which helps improve fitness and sleep and reduces anxiety
  • education about each condition
  • connecting with others who share the experience of living with POTS or fibromyalgia, for example, through a support group
  • sleep hygiene practices to promote restorative sleep

People with POTS may also find it helpful to increase their fluid and salt intake and avoid triggers such as the following:

  • prolonged sitting or standing
  • heat
  • alcohol

Below are answers to some common questions about POTS.

What is POTS often misdiagnosed as?

Doctors often misdiagnose POTS as an anxiety disorder. According to research from 2012, POTS has a history of also being misdiagnosed as panic attacks, chronic fatigue syndrome, inappropriate sinus tachycardia, and vasovagal syncope.

What does a POTS flare-up feel like?

During a POTS flare-up, a person may experience lightheadedness or dizziness with a racing heart when they stand up. They may feel forgetful and have additional signs such as a headache, visual disturbances, nausea, and tremors. Some people might lose consciousness. Symptoms fade when the person lies down.

Can you have both POTS and fibromyalgia?

Fibromyalgia is one of several conditions that commonly occur with POTS. An estimated 20% of people living with POTS also have fibromyalgia.

POTS and fibromyalgia can occur together and have some common characteristics. They are both neurological, can follow a viral infection such as COVID-19, and occur more often in females than males.

Both conditions can be debilitating and interfere with a person’s daily routine. Therapy, medication, and self-management may be effective for treating both POTS and fibromyalgia.