Yes, a concussion can lead to POTS, and it can also push blood pressure up or down. In a tilt table study of 34 teenagers with lingering concussion symptoms that included lightheadedness, 14 met POTS criteria, and 9 of the 12 who were retested later no longer did (Heyer et al., 2016). POTS that starts after a head injury is treated with the same core tools used for other POTS, plus care for the concussion symptoms that overlap with it.
POTS treatment in Provo, Utah
Dizzy, lightheaded or racing heart since your concussion?
Our 5-day POTS program treats POTS that started after a head injury, along with the concussion symptoms that come with it. Tell us what you are dealing with, then talk it through with our team on a free video consult.
Book my free consult How the program works
Starts with our POTS intake form, then you pick a time for a 15 to 30 minute video call. Prefer to talk? Call (385) 375-8590.
Yes. A concussion can disrupt the autonomic nervous system, which runs heart rate, blood pressure, breathing and digestion without you thinking about it. When that system misfires, the problem is called dysautonomia. Postural orthostatic tachycardia syndrome (POTS) is one type of dysautonomia.
Doctors diagnose POTS when your heart rate rises by at least 30 beats per minute (40 for ages 12 to 19) within 10 minutes of standing up or being tilted upright, without a large drop in blood pressure, and you have ongoing symptoms such as lightheadedness, a racing heart, fatigue or brain fog (Thijs et al., 2021).
A 2018 systematic review found 36 studies that measured autonomic function after concussion, and only 3 of them found no abnormalities. The authors concluded that concussion likely causes autonomic nervous system changes (Pertab et al., 2018). At a large pediatric hospital, 11.4% of people diagnosed with POTS said their symptoms began within 3 months of a concussion (Miranda et al., 2018).
After a head injury, posture-related problems can show up in a few ways:
Three patterns after a head injury
What happens to your numbers when you stand up?
A standing or tilt test compares your heart rate and blood pressure lying down and upright. The dashed line shows a typical response.
Orthostatic tachycardia
Heart rate climbs at least 30 bpm (40 bpm ages 12 to 19) within 10 minutes, without a big blood pressure drop, plus ongoing symptoms.
Orthostatic hypotension
Blood pressure falls when you stand.
Orthostatic hypertension
Blood pressure rises when you stand.
Simplified illustration, not real patient readings. Criteria: Thijs RD et al., Clin Auton Res 2021 (PMID 33740206).
Only the first pattern, combined with ongoing symptoms, fits POTS. Some doctors use "POTS" and "dysautonomia" as if they mean the same thing, so ask which pattern your tests showed.
POTS after a concussion may also behave differently from other POTS. Most POTS patients are young women, but in a UCLA concussion clinic study, post-concussion orthostatic tachycardia showed up at similar rates across ages and sexes (Pearson et al., 2022).
Yes. A concussion or other head injury, including a fall or a hit to the head, can push blood pressure up or down because it can disrupt the autonomic nervous system that controls how tight or relaxed your blood vessels are. Some people see a change in only the top (systolic) or bottom (diastolic) number, or only during exercise or standing. In our clinic, some patients have these changes for months.
Changes our post-concussion patients describe (clinic observations, not a diagnostic checklist):
A racing heart after a concussion can also happen without POTS (see heart rate changes after concussion).
If you have just hit your head and notice a sudden change in your blood pressure, see a doctor right away. Get emergency care for fainting that caused an injury, chest pain during exertion, or a worsening headache, repeated vomiting or confusion after a head injury.
Most people who have a concussion do not develop POTS. Rates depend on who gets tested: low when everyone at a concussion clinic is tested, much higher among people who already feel lightheaded.
Concussion and POTS: what the studies show
How often do concussion patients meet POTS heart-rate criteria?
The answer depends on who gets tested. Three studies, three groups:
Studies used different tests and groups, so compare with care.
Teens with lingering symptoms that included lightheadednessTilt table test, 34 patients ages 13 to 18 (Heyer 2016)
All patients seen at a concussion clinicStanding test, 268 patients ages 8 to 25 (Pearson 2022)
Children with persisting symptoms 4 to 6 weeks after injuryStanding test, 64 children ages 8 to 18 (Stein 2026)
What this means for you: Most people who have a concussion do not develop POTS. If you get lightheaded, dizzy or a racing heart when you stand, a standing or tilt test is worth asking for. In the tilt study, 9 of the 12 teens who were retested no longer met POTS criteria, and all 9 also had fewer concussion symptoms.
What treatment for POTS after a concussion usually involves
Most of this research is in children and young adults. If you are an adult, the same standing and tilt tests apply, and our program treats people 16 and older.
In a 2026 prospective study of children with persisting symptoms 4 to 6 weeks after a concussion, POTS was about as common as in healthy children, and the authors concluded that POTS is neither common nor overrepresented in that group (Stein and Barlow, 2026). That does not rule POTS out for you or your child; a standing test is the way to find out.
When you stand, gravity pulls blood toward your legs, and your nervous system responds within seconds by tightening blood vessels and nudging your heart rate up. In POTS, that adjustment falls short or overshoots.
What happens when you stand up
Your body has seconds to adjust
The same first step happens to everyone. What differs is how the nervous system responds.
Typical response
With POTS
Simplified. POTS has several forms, and researchers are still studying why the adjustment goes wrong after a head injury.
Researchers are still working this out. In a 2026 University of Colorado study, 10 people with both POTS and a past mild brain injury had larger heart-rate rises during tilt, and larger responses to some motion tests, than 10 healthy controls, which the authors suggest may involve the inner-ear balance system (Wynn et al., 2026). Whiplash, fast shallow breathing, poor sleep and stress may also play a part, though these ideas are less studied. Our post on post-concussion dysautonomia covers the mechanisms in more depth.
Your symptoms are not "all in your head" or caused by your mindset. Anxiety and dysautonomia can feed each other, and that overlap is one reason POTS gets missed. In a large survey of 4,835 people with POTS, 77% had been told their symptoms were psychiatric or psychological before they were diagnosed, and diagnosis took an average of 4.9 years and about 7 doctors (Shaw et al., 2019). See why POTS is misdiagnosed as anxiety for how to push for proper testing.
The long road to a POTS diagnosis
If you have been passed from doctor to doctor, you are not alone
You do not need a diagnosis to talk with us. Day 1 of our program includes autonomic testing, including a tilt table test.
Survey of 4,835 people with POTS: Shaw BH et al., J Intern Med 2019 (PMID 30861229).
Does this sound like your recovery?
Common reasons people reach out to us
If this sounds familiar, talk with our POTS team about whether the 5-day program fits.
Book my free consultThis list is not a diagnosis. Prefer to talk? Call (385) 375-8590.
It can. A concussion adds symptoms that overlap heavily with POTS: headaches, dizziness, fatigue, brain fog, light sensitivity and trouble with exercise. Even if your heart rate response stays the same, the combined load can make daily life much harder.
Direct research is limited. In the UCLA study, prior concussions were more common among patients who developed orthostatic tachycardia after their latest one (Pearson et al., 2022).
If you have POTS and hit your head:
Extra fluids and salt raise blood volume, and compression garments keep blood from pooling in the legs. Some people also need medication. These help many people with POTS and stay in the plan when other treatments are added. Your doctor should guide salt and medication choices, especially if you have high blood pressure or a heart or kidney condition. For non-drug options, see managing POTS without medication.
Exercise training is one of the most studied POTS treatments, and it has to start low. The Levine (Dallas) protocol begins with recumbent exercise such as rowing or a recumbent bike and builds toward upright work over about 3 months. In the first study, 25 patients started, 19 finished, and 10 of those 19 no longer met POTS criteria (Fu et al., 2010). In a larger registry, 251 people enrolled, 103 finished, and 71% of those who finished no longer met criteria (George et al., 2016). Finishing is the hard part, so the plan should match your tolerance week by week.
A 2018 physical therapy review suggests that adding an individual POTS exercise plan to concussion rehab may be useful, starting with recumbent exercise and adjusting the dose as tolerance changes (Miranda et al., 2018).
Research on breathing in POTS is early. In one lab study of 30 people with POTS, slow breathing (about 6 breaths a minute) during a single tilt test lowered the heart-rate rise by about 7 beats per minute and eased symptoms (Stick et al., 2024). That was one session, but slow breathing costs nothing to learn.
In the Heyer tilt study, every teen whose POTS resolved also had fewer concussion symptoms (Heyer et al., 2016). That does not prove one caused the other, but it is a reason to treat both. If balance or vision problems are part of your picture, ask whether vestibular (balance) and vision work belongs in your plan.
Our POTS program grew out of treating post-concussion patients who also had POTS symptoms, and we now treat POTS patients frequently, including POTS that started after a concussion. Our program is built on the idea that POTS involves how the nervous system adjusts heart rate and blood flow when you stand. So along with the usual tools, we train that adjustment directly.
Your week in Provo
What the 5 days look like
Treatment includes breathing retraining aimed at how your body handles carbon dioxide; the Cranial Nerve Stack, a short morning routine done before you get out of bed; NeuroCardio Training, which is supervised interval training with heart-rate monitoring focused on recovery between efforts; vestibular and vision training; isometric training; and relaxation training. Fluids, salt, compression and any medication you take stay in your plan.
Every exercise session is supervised. We use heart rate and blood pressure monitors, and the team does everything it can to reduce the risk of fainting. If you feel faint during a session, staff have you lie down and help you recover with breathing work and extra fluids.
Your care team in Provo
The people who will treat you
Dr. Alina K. Fong, PhDClinical Director
Dr. Lynn M. Gaufin, MDDirector of Neurosurgery
Sotero Perigo, MS, ATCNeuroMuscular Therapist
Annie Morgan, RNDirector of Patient Care
Plus other therapists as needed. Meet the full team
If your child is under 16, talk with their doctor about a pediatric POTS clinic. If you have known heart disease, chest pain with exertion, or fainting that has caused injuries, see your doctor first and mention it on your consult.
Cognitive FX also runs a post-concussion treatment program. If headaches, memory trouble or light sensitivity are your main problems rather than POTS, the consult team can tell you which program fits better.
Questions before you start? Call (385) 375-8590 or our patient care coordinator at 385-446-4158.
Next steps
Ready to talk about POTS after your concussion?
Book my free consult Read about the POTS program
Questions first? Call (385) 375-8590. A parent or guardian must come with any patient under 18.
Related reading: POTS exercise program guide, physical therapy for POTS, neurologists vs. cardiologists for POTS and how to choose a POTS clinic.
Yes. A concussion can disrupt the autonomic nervous system, and POTS is one form that disruption can take. Most people who have a concussion do not develop POTS, so a standing or tilt test is the way to find out.
It varies, and research does not give a reliable timeline. In our clinic, some patients have blood pressure changes that last for months. Check your blood pressure at home on a regular schedule, keep a log, and see your doctor if readings are high, new since your injury, or come with chest pain, severe headache or confusion.
It varies. In one study of young patients with orthostatic intolerance after concussion, the median time from evaluation to symptom resolution was 120 days. Some people have symptoms for much longer. If yours have lasted more than a few months, ask your doctor about a standing or tilt test and treatment for any concussion symptoms that remain.
It can. A concussion adds headaches, dizziness, fatigue and brain fog on top of POTS symptoms. If you have POTS and hit your head, get checked for concussion, track your heart rate and symptoms, and ask for a repeat standing or tilt test if your POTS symptoms change.
The 5-day program costs $4,500. You can pay by credit card, finance through CareCredit, or use an HSA or FSA if your plan allows. Travel and lodging are not included.
A diagnosis helps but is not required; the Day 1 evaluation includes autonomic testing, including a tilt table test. After you finish the intake form, you pick a time for a free 15 to 30 minute video call. We go over your symptoms and tests, answer questions about cost, travel and safety, and tell you whether the program fits. The program is for people 16 and older.
Sources
This article is general education and is not medical advice. Talk with your doctor about your own symptoms and treatment.
UC San Diego Health offers various pathways for patients to be assessed and treated for concussions. Their main focus involves treating recently acquiredsports-related head injuries, but patients...
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