Dizziness or Fainting

Orthostatic hypotension (OH) is a drop in blood pressure that happens when you go from a seated position or lying down to standing. Certain medications (including those for high blood pressure), dehydration and conditions such as heart disease increase this risk.

When orthostatic hypotension is related to a neurologic disorder like Parkinson’s, it’s called neurogenic OH, or nOH. Damage caused by nervous system disorders, including Parkinson’s, can result in the nervous system not being able to make or release norepinephrine, a chemical that constricts blood vessels and raises blood pressure. This causes dizziness or lightheadedness.

nOH Symptoms

  • Lightheadedness
  • Dizziness
  • Weakness
  • Difficulty thinking
  • Headache
  • Blurred or dimmed vision

Neurogenic OH tends to be underdiagnosed. It is usually identified because people get dizzy or start to black out when they stand up. Early in the PD progression, you might not notice the dizziness, but you may experience the foggy thinking or memory problems.

Managing nOH

If you become lightheaded upon standing, report it to your doctor. In general, asking your doctor to screen you for nOH once a year is a good idea. This is done by taking your blood pressure while lying down and then standing. A drop of 20 points in the top number (systolic) or 10 points in the bottom number (diastolic) indicates nOH.

If you receive a diagnosis of nOH, talk to your doctor about reducing or eliminating certain medications (such as anti-hypertensives and some dopaminergic medications).

There are also several lifestyle strategies you can try:

  • Drink more fluids to keep hydrated. 
  • Consume more salt and caffeine. 
  • Wear thigh-high support stockings. Compression garments such as antigravity stockings can be effective in preventing OH.
  • Monitor your blood pressure.
  • Sleep with your head elevated between 10 and 30 degrees.
  • Change positions slowly, especially when rising from a seated to a standing position. Pause for several seconds between each move.
  • Be aware of behaviors and circumstances that can make nOH worse:
  • Exposure to heat
  • Fever
  • Prolonged standing
  • Vigorous exercise
  • Drinking alcohol
  • Straining while going to the bathroom
  • Meals high in carbohydrates

If these strategies do not help, there are several medications available to treat nOH. To learn more, call our Helpline at 1-800-4PD-INFO (473-4636) or read our book Parkinson’s Disease: Medications. Then talk to your doctor about your options.

For more insights on this topic, listen to our podcast episode “Understanding Neurogenic Orthostatic Hypotension.”

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