Clinical Improvement in Postural Orthostatic Tachycardia Syndrome (POTS) Following Prolotherapy and Cervical Curve Correction: 4 Case Series of Patients with Hypermobile Ehlers-Danlos Syndrome (hEDS) and Suspected Cervicovagopathy

Background: Postural orthostatic tachycardia syndrome (POTS) is common in hypermobile Ehlers-Danlos syndrome (hEDS). This retrospective case series presents 4 cases of improvement in POTS symptoms in patients with hEDS following combined intervention of prolotherapy and at-home cervical curve correction protocols.

Objective: We present the clinical histories and objective test findings of 4 patients with hEDS and POTS who underwent prolotherapy and cervical curve correction protocols to treat ligamentous cervical instability, with observed objective and subjective clinical changes, including improvement of POTS symptoms.

Results: All 4 patients had significant cervical structural abnormalities: ligamentous cervical instability at the atlantoaxial joint and forward head posture identified with digital motion x-ray (DMX), and decreased vagus nerve and internal jugular vein (IJV) cross-sectional areas (CSA) identified with ultrasound. Following prolotherapy treatments and an individualized curve correction protocol, all 4 patients demonstrated objective changes and self-reported improvement of their POTS symptoms.

Conclusion: These cases describe patients with hEDS and POTS who demonstrate radiologically identified ligamentous cervical instability and structural forward head posture, and ultrasound-identified decreased vagus nerve and IJV CSAs. Prolotherapy and cervical curve correction were associated with improvements in objective test measures, as well as meaningful self-reported improvement in POTS symptoms. These findings raise the possibility that reduced vagus nerve CSA may contribute to POTS symptoms in the context of structural cervical spine abnormalities.