Fibromyalgia is a chronic pain condition that affects millions of people worldwide. While it is primarily known for causing widespread pain, fatigue, and cognitive issues (fibro fog), many patients also experience dizziness upon standing, known as orthostatic hypotension (OH).
Orthostatic hypotension is a condition in which blood pressure drops suddenly when a person moves from a sitting or lying position to standing, leading to symptoms such as:
✔ Dizziness and lightheadedness
✔ Feeling faint or weak
✔ Blurred vision
✔ Heart palpitations
✔ Nausea
For individuals with fibromyalgia, autonomic nervous system dysfunction, poor circulation, and medication side effects may contribute to orthostatic hypotension, making everyday activities more challenging.
This article will explore the connection between fibromyalgia and dizziness upon standing, its causes, symptoms, and effective management strategies.
1. What Is Orthostatic Hypotension?
Orthostatic hypotension (OH) occurs when blood pressure drops by at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing. This sudden drop in blood pressure can cause:
🚨 Dizziness
🚨 Fainting (syncope)
🚨 Weakness and confusion
In fibromyalgia patients, orthostatic hypotension may be linked to dysautonomia, low blood volume, and nervous system imbalances.
2. The Connection Between Fibromyalgia and Orthostatic Hypotension
Although fibromyalgia is primarily a pain disorder, it also affects the autonomic nervous system (ANS), which regulates:
✔ Heart rate and blood pressure
✔ Blood circulation
✔ Temperature regulation
Dysautonomia, a dysfunction of the autonomic nervous system, is commonly seen in fibromyalgia and can impair the body’s ability to regulate blood pressure properly.
This leads to frequent episodes of dizziness upon standing, heart palpitations, and fatigue.
3. Causes of Dizziness Upon Standing in Fibromyalgia
Several factors contribute to orthostatic hypotension in fibromyalgia patients, including:
1. Dysautonomia (Autonomic Nervous System Dysfunction)
✔ Fibromyalgia is linked to autonomic nervous system imbalances, which disrupt blood pressure regulation.
✔ This leads to difficulty maintaining stable blood pressure when transitioning from sitting to standing.
2. Low Blood Volume and Circulatory Issues
✔ Many fibromyalgia patients have low blood volume, which makes it harder for the body to maintain proper circulation when standing.
✔ Poor circulation can lead to blood pooling in the lower extremities, reducing the amount of oxygen-rich blood reaching the brain.
3. Medication Side Effects
✔ Antidepressants, pain medications, and muscle relaxants commonly prescribed for fibromyalgia can lower blood pressure and contribute to dizziness.
✔ Opioids, sedatives, and anti-anxiety drugs can further increase the risk of orthostatic hypotension episodes.
4. Adrenal and Hormonal Imbalances
✔ Fibromyalgia patients often experience adrenal fatigue, leading to low cortisol levels and blood pressure instability.
✔ Thyroid dysfunction, which is common in fibromyalgia, can also contribute to dizziness and hypotension.
5. Dehydration and Electrolyte Imbalances
✔ Inadequate fluid intake and low sodium levels can reduce blood volume and make it harder for the body to maintain blood pressure.
✔ Chronic dehydration can worsen symptoms of lightheadedness, weakness, and brain fog.
6. Postural Orthostatic Tachycardia Syndrome (POTS)
✔ Some fibromyalgia patients also develop POTS, a condition where standing up causes the heart to race while blood pressure drops.
✔ POTS is linked to autonomic nervous system dysfunction and can cause severe dizziness, fatigue, and palpitations.
4. Symptoms of Orthostatic Hypotension in Fibromyalgia
The most common symptoms of dizziness upon standing in fibromyalgia include:
✔ Dizziness or lightheadedness when standing up
✔ Blurry vision
✔ Feeling weak or fatigued
✔ Heart palpitations or racing heartbeat
✔ Cold hands and feet
✔ Brain fog and difficulty concentrating
✔ Nausea and headaches
These symptoms can range from mild to severe and may worsen with heat, dehydration, stress, or prolonged standing.
5. Risks of Untreated Orthostatic Hypotension in Fibromyalgia
If left unmanaged, orthostatic hypotension can increase the risk of:
🚨 Frequent falls and injuries
🚨 Reduced blood flow to the brain
🚨 Extreme fatigue and cognitive issues
🚨 Increased heart strain and circulation problems
Since fibromyalgia already causes chronic pain and fatigue, dealing with frequent dizziness upon standing can further impact daily activities and quality of life.
6. How to Manage Dizziness Upon Standing in Fibromyalgia
1. Increase Salt and Electrolyte Intake
✔ Sodium helps raise blood pressure, so increasing salt intake can help prevent dizziness.
✔ Drink electrolyte-rich fluids (such as coconut water or sports drinks) to maintain proper hydration.
2. Stay Hydrated
✔ Dehydration worsens low blood pressure, so drink at least 8–10 glasses of water per day.
✔ Avoid excessive caffeine and alcohol, which can contribute to dehydration.
3. Move Slowly When Changing Positions
✔ To prevent dizziness, transition slowly from lying down to sitting, and from sitting to standing.
✔ If you feel lightheaded, sit down and rest before attempting to stand up again.
4. Wear Compression Stockings
✔ Compression stockings help improve circulation and prevent blood from pooling in the legs.
✔ This reduces the risk of dizziness, fainting, and fatigue.
5. Eat Small, Frequent Meals
✔ Large meals can cause postprandial hypotension (a drop in blood pressure after eating).
✔ Eating smaller meals throughout the day can help stabilize blood pressure.
6. Monitor Medications
✔ If you suspect fibromyalgia medications are causing low blood pressure, talk to your doctor about adjusting your dosage.
✔ Avoid medications that excessively lower blood pressure or cause drowsiness.
7. Engage in Gentle Exercise
✔ Mild exercises like yoga, stretching, and slow walking can help improve circulation.
✔ Avoid high-intensity workouts that may trigger dizziness and worsen fatigue.
8. Strengthen Your Nervous System
✔ Fibromyalgia affects the autonomic nervous system, so supporting nerve health can help manage symptoms.
✔ Deep breathing, meditation, and stress reduction techniques may improve blood pressure regulation.
7. Conclusion: Managing Dizziness Upon Standing in Fibromyalgia
Dizziness upon standing (orthostatic hypotension) is a common but often overlooked symptom in fibromyalgia patients. It is closely linked to dysautonomia, low blood volume, medication side effects, and adrenal dysfunction.
By making dietary changes, staying hydrated, adjusting medications, and improving circulation, fibromyalgia patients can reduce dizziness episodes and improve daily function.
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