Cortez, Melissa

Abstract Purpose: Adolescents with chronic orthostatic intolerance (COI) experience symptoms related to impaired tolerance of upright posture. Postural Orthostatic Tachycardia Syndrome (POTS) is a specific type of COI, marked by an excessive increase in heart rate (≥40 bpm or an absolute HR >120 bpm) when standing. This study compares Functional Disability Inventory (FDI) scores between adolescents with COI with and without excessive postural tachycardia (POTS subtype). Methods: Patients ≤19 years referred to our POTS program (Aug 2024–Mar 2025) with orthostatic symptoms for>3 months were included. Based on active stand HR, patients were categorized as POTS (HR ≥40 bpm) or COI without excessive postural tachycardia (HR <40 bpm). FDI scores were collected. Chi-square tests assessed group differences. A two-sample t-test compared FDI severity. Linear regression evaluated the association between HR change and FDI score. Results: All data were normally distributed, allowing the use of parametric analyses. Of the 92 patients (46 per group), 78% were female. The mean age was 16.0 ± 1.48 years in the COI group and 16.3 ± 1.7 years in the POTS group, with no significant sex differences between groups. The COI group had a higher mean FDI score than the POTS group, but this difference was not statistically significant. The distribution of FDI severity (mild, moderate, severe) was similar between groups. Linear regression showed a non-significant trend of a 1 bpm increase in heart rate associated with a 0.1055-point decrease in FDI score Conclusion: Functional disability was similar between the COI and POTS groups.

Abstract Objective To examine whether sensory hypersensitivity contributes to headache‐related disability in a secondary analysis of patients with post‐traumatic headache. Background Up to one‐third of individuals with traumatic brain injuries report persistent headache 3 months post‐injury. High rates of allodynia and photophobia have been observed in clinical studies and animal models of post‐traumatic headache, but we do not fully understand how sensory amplifications impact post‐traumatic headache‐related disability. Methods We identified a cross‐sectional sample of patients from the American Registry for Migraine Research database with new or worsening headaches post‐head injury from 2016 to 2020 and performed a secondary analysis of those data. We modeled the relationship between sensory sensitivity and Migraine Disability Assessment scores using questionnaires. Candidate variables included data collection features (study site and year), headache‐related and general clinical features (headache frequency, migraine diagnosis, abuse history, sex, age, cognitive and affective symptom scores), and sensory symptoms (related to light, sound, and touch sensitivity). Results The final sample included 193 patients (median age 46, IQR 22; 161/193, 83.4% female). Migraine Disability Assessment scores ranged from 0 to 260 (median 47, IQR 87). The final model included allodynia, hyperacusis, photosensitivity, headache days per month, abuse history, anxiety and depression, cognitive dysfunction, and age ( R 2 = 0.43). An increase of one point in allodynia score corresponded to a 3% increase in headache disability (95% CI: 0%–7%; p = 0.027), an increase of one‐tenth of a point in the photosensitivity score corresponded to a 12% increase (95% CI: 3%–25%; p = 0.002), and an increase of one point in the hyperacusis score corresponded to a 2% increase (95% CI: 0%–4%; p = 0.016). Conclusions Increased photosensitivity, allodynia, and hyperacusis were associated with increased headache‐related disability in this sample of patients with post‐traumatic headache. Symptoms of sensory amplification likely contribute to post‐traumatic headache‐related disability and merit an ongoing investigation into their potential as disease markers and treatment targets.