Fibromyalgia and POTS: Is Fibromyalgia a Form of Dysautonomia?

How Often Does Dysautonomia Show Up in Fibromyalgia?

Dysautonomia is the umbrella term for problems with the autonomic nervous system, the part that runs heart rate, blood pressure, digestion, sweating and temperature without you thinking about it. A 2021 review in the Internal Medicine Journal places fibromyalgia among the "central sensitivity syndromes," a group defined by how the central nervous system processes signals.

Studies report dysautonomia often in chronic musculoskeletal pain. A 2026 systematic review and meta-analysis pooled 17 studies covering 1,003 people with chronic musculoskeletal pain and 417 healthy controls. Of those studies, 13 were in fibromyalgia, 3 in Ehlers-Danlos syndrome and 1 in rheumatoid arthritis. The pooled prevalence of dysautonomia was 64% (95% CI 51 to 76), and people with chronic musculoskeletal pain were 2.28 times as likely to have it as healthy controls (95% CI 1.51 to 3.45). Most of the studies tested the nerves that control heart rate and blood pressure, so the 64% isn't a rate of POTS. The studies varied widely (a heterogeneity score, I², of 93%), so the 64% is a pooled estimate across pain conditions and doesn't describe every person with fibromyalgia.

Musculoskeletal pain Vs healthy controls

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Can You Have Fibromyalgia and POTS at the Same Time?

People with fibromyalgia can also have POTS, which is one form of dysautonomia. A 2026 review of fibromyalgia and dysautonomia reports abnormal heart rate variability, abnormal cardiovascular regulation on standing, and POTS in patients with fibromyalgia. There's no reliable rate yet for POTS among people with fibromyalgia.

From the POTS side, a 2026 meta-analysis of POTS studies (19 studies, 8,268 patients in all) estimated fibromyalgia in about 22% of people with POTS (95% CI 13 to 34), with substantial variation between studies. Our POTS symptoms checklist covers that meta-analysis by body system. On our hypocapnic cerebral hypoperfusion (HYCH) page, fibromyalgia was about as common in HYCH (15.8%) as in POTS (14.5%).

How Do You Check for POTS if You Have Fibromyalgia?

POTS is confirmed by a sustained heart rate rise of 30 or more beats per minute within 10 minutes of standing (40 or more in teens), with symptoms and no drop in blood pressure. A tilt test with transcranial Doppler also shows whether blood flow to the brain holds up while you're upright, which a standard tilt doesn't measure. The 2026 chronic pain meta-analysis also included 3 studies in Ehlers-Danlos syndrome; our page on POTS and EDS covers why those 2 show up together.

What Do Fibromyalgia and POTS Have in Common?

Central sensitization shows up on both sides. The 2021 Internal Medicine Journal review describes it as "mediated by amplified processing in the central nervous system" and names it the key mechanism in the central sensitivity syndromes. Fibromyalgia often overlaps with others in that group, such as irritable bowel syndrome, chronic fatigue syndrome and temporomandibular disorder. On the POTS side, a 2026 study in JAMA Network Open found that 264 of 305 POTS patients (86.6%) scored in the central sensitization range on the Central Sensitization Inventory, a standard questionnaire.

In the clinic's view, a lot of what people with fibromyalgia feel, such as generalized fatigue or muscle pain, traces back to problems in the brain, so that's where our team looks first. That's the overlap our team means: both conditions trace back to how the brain handles signals, pain in fibromyalgia and heart rate and blood flow in POTS.

Does Brain Blood Flow Change in Fibromyalgia?

The research here is small and mixed. A 2012 transcranial Doppler study of 25 women with fibromyalgia and 25 healthy participants, tested with painful heat, found a steeper early rise in blood flow through the anterior cerebral arteries, at the front of the brain, in the patients than in the controls. A 2017 study of 15 people with fibromyalgia and 15 controls, measured at rest, found the pattern of blood flow speed at rest differed from controls, though the study didn't show more or less flow overall.

A 2018 study of 30 women with fibromyalgia and 30 healthy women, scanned lying down, looked at total volume instead. It found that brain blood flow volume, and flow through the internal carotid and vertebral arteries, wasn't significantly higher in fibromyalgia than in controls. None of these studies tested brain blood flow during a stand or tilt, which is when POTS symptoms show up, and that's what a tilt test with transcranial Doppler checks. These studies are too small and too mixed to call fibromyalgia a brain blood flow condition. For how brain blood flow is measured and what can restrict it, see can tight neck muscles restrict blood flow to the brain.

Why Does Fibromyalgia Feel Dismissed?

In the clinic's view, chronic fatigue and fibromyalgia were once an "in vogue" throwaway diagnosis. The diagnosis still exists and still carries that connotation, and it overlaps with other diagnoses where people tell you it's all in your head.

Chronic fatigue syndrome is one of those overlapping diagnoses. Our page on ME/CFS vs POTS covers how the 2 differ and whether you can have both.

Fibromyalgia and POTS: FAQ