POTS After Concussion: Symptoms, Blood Pressure & Treatment
Have you noticed that you feel significantly worse when you stand up after a concussion?
Maybe your heart starts racing.
You feel dizzy or lightheaded.
Your brain fog gets worse.
You feel exhausted after standing or walking.
Or exercise that used to feel easy suddenly feels impossible.
For some people, these symptoms may be related to orthostatic intolerance or autonomic dysfunction after a concussion. In some cases, a person may meet the criteria for Postural Orthostatic Tachycardia Syndrome (POTS).
POTS has been recognized in people following concussion, and symptoms can overlap significantly with persistent post-concussion symptoms—including dizziness, fatigue, headache, brain fog, and exercise intolerance.
But here's the important part:
Not everyone who experiences dizziness, a racing heart, or blood-pressure changes after a concussion has POTS.
Understanding the difference can help you figure out what may actually be contributing to your symptoms and what type of treatment may be appropriate.
What Is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome.
"Postural" refers to body position.
"Orthostatic" means upright.
"Tachycardia" means a fast heart rate.
"Syndrome" means a collection of symptoms that occur together.
For adults, a commonly used diagnostic criterion is an increase in heart rate of at least 30 beats per minute within 10 minutes of standing or head-up tilt, in the absence of orthostatic hypotension and after other causes have been considered.
POTS is not simply "low blood pressure."
In fact, blood pressure can be normal, low, or sometimes increase when someone with POTS stands.
That's why looking only at blood pressure doesn't tell the whole story.
Can a Concussion Cause POTS?
A concussion may be associated with the development or worsening of orthostatic intolerance and autonomic symptoms in some people.
However, it's more accurate to say that POTS can occur following concussion rather than saying that concussion always causes POTS.
Research specifically examining concussion and POTS has identified a subset of people whose POTS symptoms began following a concussion. One review reported that 11.4% of people in a pediatric POTS database reported symptom onset within three months of a concussion.
That does not mean 11.4% of people with concussion develop POTS.
It means that among the people in that particular POTS database, 11.4% reported that their symptoms began within three months of a concussion.
That's an important distinction.
The relationship between concussion and autonomic dysfunction is an active area of research.
A 2023 review found evidence suggesting that altered cardiovascular autonomic regulation may contribute to exercise intolerance following concussion, but also emphasized that the available studies vary considerably and that more research is needed.
What Does POTS Feel Like After a Concussion?
POTS symptoms can overlap with many common concussion symptoms.
This is one reason it can be difficult to recognize.
You may experience:
Dizziness or lightheadedness when standing
A rapid increase in heart rate when upright
Heart palpitations
Fatigue
Brain fog
Headaches
Exercise intolerance
Shortness of breath
Nausea
Feeling worse after prolonged standing
Feeling better when lying down
Feeling faint or actually fainting
The combination can be frustrating because you may feel fine lying down but significantly worse once you're upright.
For example, you might be able to lie on the couch and read for 30 minutes but then feel terrible after standing in the kitchen for 10 minutes.
Or you may tolerate a short walk but experience a significant increase in symptoms afterward.
Why Do I Feel Worse When I Stand Up After a Concussion?
When you stand, gravity causes some blood to pool in the lower part of your body.
Your cardiovascular system has to respond quickly to maintain adequate circulation.
Your autonomic nervous system helps coordinate this response.
If that regulation isn't working normally, you may experience symptoms such as:
Increased heart rate
Dizziness
Lightheadedness
Fatigue
Brain fog
Exercise intolerance
Autonomic dysfunction has been reported following mild traumatic brain injury, although the quality of the evidence varies substantially between studies.
A more recent 2026 review describes post-concussion dysautonomia as an increasingly recognized complication and emphasizes that symptoms can overlap with other post-concussion conditions.
Is POTS a Blood Pressure Problem?
Not necessarily.
This is an important misconception.
POTS is primarily defined by the heart-rate response to standing, along with orthostatic symptoms.
Blood pressure may remain relatively stable, decrease, or increase depending on the individual and the underlying physiology.
Some people with autonomic dysfunction may also experience unusual blood-pressure responses when they stand.
There is even a separate condition called orthostatic hypertension, in which blood pressure increases significantly after standing. This is different from POTS.
So if you're experiencing:
high blood pressure + dizziness + heart-rate changes when standing
that doesn't automatically mean you have POTS.
It may be worth discussing the pattern with a physician who is familiar with autonomic disorders.
How Do You Know If You Have POTS After a Concussion?
POTS is a medical diagnosis.
Symptoms alone aren't enough.
A healthcare professional may evaluate:
Heart rate when lying down
Heart rate after standing
Blood pressure changes
Symptoms during standing
Medical history
Medications
Hydration status
Other possible causes of tachycardia or dizziness
A standing test or tilt-table test may be used depending on the situation.
Importantly, other conditions can cause similar symptoms.
For example:
Dehydration
Anemia
Thyroid disorders
Medication effects
Cardiac conditions
Anxiety or panic
Other forms of autonomic dysfunction
need to be considered.
That's why I would not recommend diagnosing yourself with POTS based solely on a smartwatch heart-rate reading.
Why Can POTS Be Confused With Persistent Concussion Symptoms?
This is one of the biggest challenges.
Imagine someone who has:
Dizziness + fatigue + brain fog + headaches + exercise intolerance
Those are all common post-concussion symptoms.
But they're also symptoms that can occur with POTS.
This overlap can make it difficult to determine whether someone is dealing with:
Persistent concussion symptoms
Orthostatic intolerance
POTS
Vestibular dysfunction
Cervical dysfunction
Exercise intolerance
Sleep disruption
A combination of several of these
And sometimes there is more than one contributor.
This is why I don't believe concussion recovery should be approached as if every person has the exact same problem.
Why Does Exercise Make My POTS or Concussion Symptoms Worse?
If you have POTS or post-concussion exercise intolerance, exercise can initially make you feel worse.
This can be extremely frustrating.
You may think:
"If exercise is supposed to help me, why do I feel worse every time I exercise?"
The answer may be that the dose and position of exercise matter.
A person who cannot tolerate 20 minutes of upright jogging may be able to tolerate a shorter period of recumbent cycling.
That doesn't mean they're incapable of exercising.
It means their starting point may need to be different.
Research on concussion-related autonomic dysfunction suggests that exercise intolerance may be related to altered cardiovascular autonomic regulation, although the exact mechanisms are still being investigated.
What Kind of Exercise Is Helpful for POTS?
Exercise is an important part of POTS management for many people—but how you start matters.
Traditional upright exercise may be too challenging initially for someone who becomes significantly symptomatic when standing.
For some people, beginning with recumbent or semi-recumbent exercise can make it possible to train without immediately provoking the same degree of orthostatic stress.
Examples may include:
Recumbent cycling
Semi-recumbent cycling
Rowing
Swimming
As tolerance improves, exercise can gradually progress toward more upright activities.
A review of non-pharmacological POTS treatment describes horizontal exercise as an important starting strategy for some patients, with gradual progression toward upright exercise as tolerated.
Can Exercise Actually Improve POTS?
Yes.
Exercise training is one of the important non-medication strategies used in POTS management.
In one community-based study, a structured exercise and lifestyle program was associated with improvements in heart-rate response and quality of life in people with POTS.
But this does not mean:
"Exercise harder and your POTS will go away."
That's not the message.
The message is:
Your cardiovascular system can often be trained—but the starting point and progression need to be individualized.
This is particularly important when POTS and concussion symptoms overlap.
What About Hydration and Electrolytes?
Hydration can be an important part of POTS management.
Some people with POTS are advised by their healthcare providers to increase fluid and sodium intake to support blood volume.
However, this isn't appropriate for everyone.
If you have:
High blood pressure
Kidney disease
Heart disease
Another condition requiring sodium or fluid restriction
You should talk with your healthcare provider before significantly increasing salt or fluid intake.
Can Compression Help POTS Symptoms?
Compression garments can sometimes help reduce blood pooling in the lower body when standing.
Research has found that abdominal and lower-body compression can reduce heart-rate increases and improve orthostatic symptoms in people with POTS.
This may be something to discuss with your healthcare provider, particularly if standing causes significant symptoms.
Can Physical Therapy Help POTS After a Concussion?
Physical therapy can be useful when POTS or orthostatic intolerance is affecting your ability to exercise and return to normal activity.
The role of physical therapy may include:
Determining an appropriate starting point for exercise
Using recumbent exercise when appropriate
Gradually increasing exercise duration
Progressing toward upright exercise
Monitoring symptom response
Addressing vestibular dysfunction
Addressing balance problems
Addressing neck-related contributors
Helping you gradually return to normal activity
A concussion-focused review specifically describes a role for physical therapists in identifying signs of POTS and incorporating an individualized exercise program into concussion rehabilitation.
The key is that POTS treatment shouldn't necessarily replace concussion rehabilitation.
If you have both, the two may need to be addressed together.
What If I Don't Actually Have POTS?
This is important.
You don't need a POTS diagnosis to benefit from looking at how your body responds to upright activity and exercise.
You may have another form of autonomic dysfunction or exercise intolerance.
Or your symptoms may be coming primarily from another system.
For example:
Dizziness could be vestibular.
Headaches could involve your neck.
Brain fog could be affected by sleep, visual processing, autonomic regulation, or cognitive load.
Exercise intolerance could involve autonomic or cardiovascular responses.
And you may have several contributors at the same time.
This is why I believe concussion recovery should focus on identifying what is actually driving your symptoms, rather than simply labeling everything "post-concussion syndrome."
A More Complete Approach to Concussion Recovery
If you're still struggling months after your concussion, you may have already tried:
Rest
Avoiding exercise
Returning to exercise
Waiting for symptoms to disappear
Cutting back on screens
Sleeping more
Trying to "push through"
And yet you still don't feel like yourself.
That's exactly why I created The Concussion Solution.
If you're dealing with persistent concussion symptoms and don't know where to start, The Concussion Solution provides a structured approach you can follow from home.
The program helps you progressively work on some of the systems that can contribute to persistent symptoms, including exercise tolerance, autonomic regulation, vestibular function, visual and cognitive symptoms, neck-related symptoms, sleep, and recovery strategies.
Ready for a More Structured Approach?
When Should You See a Doctor for POTS-Like Symptoms?
If you're experiencing significant dizziness, fainting, rapid heart rate, chest pain, shortness of breath, or unusual blood-pressure changes after a concussion, it's important to discuss these symptoms with a healthcare professional.
Don't assume that every cardiovascular symptom is caused by your concussion.
Medical evaluation may be appropriate to rule out other causes and determine whether you have POTS, another form of orthostatic intolerance, or something else.
Seek urgent medical attention for chest pain, severe shortness of breath, fainting with injury, new neurological symptoms, severe or rapidly worsening headache, repeated vomiting, confusion, seizure, or other significant acute symptoms.
Frequently Asked Questions About POTS After Concussion
Can a concussion cause POTS?
Yes. POTS can occur following concussion, and concussion-related POTS has been described in the medical literature. However, not everyone who develops dizziness, fatigue, or a rapid heart rate after concussion has POTS.
What are the symptoms of POTS after concussion?
Common symptoms can include dizziness or lightheadedness when standing, rapid heart rate, fatigue, brain fog, headaches, palpitations, nausea, and exercise intolerance.
Does POTS cause high blood pressure?
POTS is primarily characterized by an excessive increase in heart rate when standing, not high blood pressure. Blood pressure can behave differently depending on the individual and the underlying autonomic pattern.
How is POTS diagnosed after a concussion?
Diagnosis typically involves assessing symptoms with upright posture and measuring heart rate and blood pressure during standing or a head-up tilt test. Other possible causes of the symptoms should also be considered.
Should I exercise if I have POTS after a concussion?
Exercise can be an important part of POTS management, but the starting position, intensity, duration, and progression should be individualized. Some people initially tolerate recumbent exercise better than upright exercise.
Can POTS symptoms improve after concussion?
Many people can improve with appropriate management, although recovery varies considerably. Exercise training and other non-pharmacological strategies are commonly used as part of POTS management.
How long does POTS last after a concussion?
There isn't a predictable timeline. POTS and post-concussion symptoms can vary significantly between individuals, and persistent symptoms should be evaluated rather than assuming they will resolve within a specific period.
Related Concussion Recovery Articles
If you're experiencing POTS-like symptoms after a concussion, these articles may also help:
High Blood Pressure After a Head Injury: Causes & What to Do
Learn about blood-pressure changes, autonomic regulation, and when elevated blood pressure should be medically evaluated.
Why Does Exercise Make My Concussion Symptoms Worse?
Learn why exercise intolerance can occur after concussion and how to approach exercise progression.
Why Are My Concussion Symptoms Getting Worse?
Understand why concussion symptoms can fluctuate and what may contribute to setbacks.
Why Do I Still Have Concussion Symptoms Months Later?
Learn why symptoms can persist and why multiple systems may contribute.
Screen Time After a Concussion: How Much Is Too Much?
Learn how to gradually return to screens without unnecessarily avoiding normal activity.
Ready for a More Structured Approach?
If you're dealing with persistent concussion symptoms and don't know where to start, The Concussion Solution provides a structured approach you can follow from home.
You'll learn how to progressively work on exercise tolerance, autonomic regulation, vestibular function, visual and cognitive symptoms, neck-related symptoms, sleep, and recovery strategies.
Looking for In-Person Concussion Care in Park City, UT?
If you live in the Park City area and would prefer one-on-one, in-person concussion physical therapy, Happy Brain Physical Therapy offers individualized concussion care in Park City, Utah
