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Coat Hanger Pain and It's Relation to Autonomic Dysfunction

Updated: Feb 19

Coat Hanger Pain

Coat hanger pain is a condition associated heavily with POTS and other kinds of dysautonomia. The term “coat hanger” comes from the particular region in which the pain is felt: the neck - specifically the suboccipital and paracervical regions.

Doctors have found that it is made worse in a head up posture, but can be temporarily alleviated by lying down. Researchers have found that it is noted in 93% of patients with autonomic dysfunction, and in 51% of patients with multiple system atrophy.

There is no concrete evidence to explain why coat hanger pain is associated with POTS and other dysuatonomia, but there is a theory. It is thought to be hypoperfusion (reduced amount of blood flow) in these important muscle groups (the traps and other muscles in the neck leading up to the brain),

This is supported by doctors because it is consistent with the crampy feeling and low blood flow nature of the pain described by patients, and its particular relationship to posture.

Symptoms of coat hanger pain can easily be mixed up with other symptoms related to EDS/HSD. But the important differentiation is that coat hanger pain goes away when lying down. We have to remember that the muscles in our neck and head are tonically active (meaning they are being used all the time, and using oxygenated blood).

As these tonically active muscles are used, they produce lactic acid, and this can cause a cramp. So imagine these tonically active muscles working off of almost no oxygenated blood due to POTS. This phenomena can explain the increased cramping and pain in the neck/head region for those with autonomic dysfunction.

Be sure to consult with your primary care physician or other medical professionals in regards to your medical concerns. This text cannot and should not replace advice from the patient's healthcare professionals. Any person who experiences symptoms or feels that something may be wrong should seek individual professional help for evaluation and/or treatment. This information is for guidance only.

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1 Comment

Tim Hofstetter
Tim Hofstetter
Dec 18, 2021

Lactic acid in muscles doesn't cause cramping.

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