Dealing with the Trigger (s)

When you have a flare-up, finding the trigger is important - if there is one. If there is a trigger, the orthostatic problem will often not get better until the trigger settles down.

The goal is to get your orthostatic symptoms to settle down. That means you will need to figure out what has triggered the change and then modify things if you can so that you can prevent future episodes.

If you know what triggered the change, either remove it or get it to settle down

If it was triggered by hot temperature outside and in the house, is the house still hot? Can you go somewhere that is cooler? Can you cool your body off? Cool shower, cold soda can on your forehead or the back of the neck, etc. Check out Manage Temperature for more ideas.

If it was triggered by an acute illness like a cold or the stomach flu, have you been in bed for a couple of days? It will probably be around for a few days. You will need to take care of yourself and make sure you get your fluids and salt.

If it is an infection that needs to be evaluated by your physician, have you been checked. Are you taking care of yourself?

If you have allergies, are you taking antihistamines? Allergies trigger the release of histamine - which makes blood vessels dilate (enlarge). It interferes with controlling blood pressure.

If you don't know what triggered the change, here's some possibilities to consider:

  1. Heat - hot temperature outside, inside in a crowd, a heated pool
  2. An acute illness like a cold or the stomach flu.
  3. Allergy - are you allergic to anything that you know of? Have you been exposed to it lately? If you have, make sure you aren't exposed anymore. Allergic reactions release the chemical histamine in the body. Histamine makes blood vessels dilate. Try an over-the-counter antihistamine to see if helps control your BP and symptoms better. (If you have had major allergic reaction, check with your physician about treating it. You can take care of this yourself if it is something you have had before and have discussed with your doctor.)
  4. Do you have delayed hypersensitivity to food proteins, like cow's milk protein? Have you been eating food with the food protein? Try to avoid it - seriously avoid it.
    • For now, it will take a while for either of these reactions to clear from your body. You will need to increase your fluids/salt and take precautions while it clears your body.
  5. Do you have asthma? Have you been taking albuterol or another beta agonist inhaler? (They are like epinephrine that is released when you stand up.)
  6. For women:
    • Is it time for your menstrual cycle (your period)
    • Do you have pain in the lower part of the abdomen, do you have like endometriosis or other pelvic problems?
  7. Are you anemic? Is it getting worse? Has it been evaluated to find what kind of anemia it is? Do you need iron supplements to correct it? (See Secondary Conditions)
  8. Have you started a new medication or herb that might be interfering with your other medication or has a side effect of lowering blood pressure? If you've been on a medication for a while and doing ok with it, has the dose been increased lately? (Check out the list)of durgs and herbs that can have symptoms with standing.)
  9. Sometimes your body does ok with 1 of these triggers, but do you have more than 1 trigger going on at once?

Always - go back and review fluids and salt intake

Sometimes, it's easy to lose track of fluids or salt intake. There might be a change in the daily routine and not notice how it has changed the fluids and salt intake.

Case Study: Ms X has started a new routine, doing a morning routine of stretching and meditation. She doesn't eat and take her salt tablets until after she has been up for 2-3 hours but she is drinking more water during that time. She has started to feel more symptoms when she stands up and moving around after she's been up for 4-5 hours.
Then later, she goes to the Y and has been drinking 2 bottles of water while she is doing her sitting exercises. She is feeling more symptoms later in the day, more headache when she is standing up. Headache when she is sitting in her chair. She wonders if something is off.

Assessment: This is a mild flare-up. She took fluids with salt tablets every 1 1/2 hours for 3 times and started to feel better.

Search for the trigger:   She reviewed her fluids and salt intake for the last 2 days: She is taking in a lot of fluids but they are mostly before she takes her salt tablets, which she takes with her meals, hours later.

Solution:   She is going to take a snack and buffered salt tablets right away in the morning before she starts her stretching. She is taking salt tablets and a small snack (to help her stomach not get upset from the salt tablets) before she goes to the Y.

Does it work?   Don't know the answer yet.

Can't find a trigger? .....

The other fact about OI, POTS and NMH is that the symptoms can be cyclical. That means that things that were working can not work so well for no reason that you can figure out. The literature notes that these are "cyclical" - there isn't an explanation or anything specific you can do about it if it is just a change in the cycle.3   You just have to do your best to get through it.

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  1. Figueroa JJ, Basford JR, Low PA.    Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306. Abstract --- Article PDF
  2. Rowe, Peter.  General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012.
  3. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ and Fischer PR. Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatr Neuro 2010; 42:77-85. Abstract.


Author: Kay E. Jewell, MD
Page Last Updated: August 6, 2012