Have you ever stood up from bed or a chair only to feel lightheaded, dizzy, or as though your vision was briefly fading?
For many people, this happens occasionally and lasts only a few seconds.
For others, it occurs every day and can interfere with work, exercise, driving, and even simple household tasks.
Although these episodes are often dismissed as “standing up too quickly,” they may actually be a sign of orthostatic hypotension (OH)—one of the most common forms of dysautonomia, a group of disorders that affect the autonomic nervous system.
The autonomic nervous system is responsible for regulating many of the body’s automatic functions, including heart rate, blood pressure, digestion, breathing, temperature regulation, sweating, and circulation. When this system is not functioning properly, a wide variety of symptoms can develop. Orthostatic hypotension is one of several conditions that fall under the dysautonomia umbrella, alongside disorders such as Postural Orthostatic Tachycardia Syndrome (POTS), vasovagal syncope, and neurocardiogenic syncope.
In orthostatic hypotension, the autonomic nervous system is unable to adequately compensate for the effects of gravity when a person stands. As a result, blood pressure drops, less blood reaches the brain, and symptoms such as dizziness, blurred vision, weakness, or even fainting can occur.
Understanding why this happens is the first step toward identifying the underlying cause and developing an effective treatment plan.
What Is Orthostatic Hypotension?
Orthostatic hypotension is one of the most frequently encountered forms of dysautonomia.
Dysautonomia refers to dysfunction of the autonomic nervous system—the part of the nervous system responsible for automatically regulating essential bodily functions without conscious effort.
In healthy individuals, the autonomic nervous system responds almost instantly when a person stands up, maintaining blood pressure and ensuring that the brain continues to receive an adequate blood supply.
In individuals with orthostatic hypotension, this automatic response is impaired.
Clinically, orthostatic hypotension is defined as:
- A drop in systolic blood pressure of 20 mmHg or more, or
- A drop in diastolic blood pressure of 10 mmHg or more
within three minutes of moving from a lying or seated position to standing.
When blood pressure falls too much, the brain may temporarily receive less oxygen-rich blood than it needs, producing the characteristic symptoms of orthostatic hypotension.
What Normally Happens When You Stand Up?
Standing up is actually a remarkable neurological challenge.
The moment you rise, gravity pulls approximately 500–800 milliliters of blood toward your legs and abdomen.
If the body failed to compensate, blood pressure would fall dramatically every time you stood.
Fortunately, the autonomic nervous system immediately detects this change.
Specialized pressure sensors called baroreceptors, located primarily in the carotid arteries and the aortic arch, continuously monitor blood pressure.
When they detect a sudden decrease, they send signals to the brainstem, which rapidly responds by:
- Increasing heart rate
- Constricting blood vessels
- Increasing the force of heart contractions
- Redirecting blood toward the brain
This entire process occurs within seconds and usually goes completely unnoticed.
In orthostatic hypotension, however, one or more parts of this reflex fail to function properly, allowing blood pressure to drop and symptoms to develop.
Common Symptoms
Symptoms vary depending on how much blood pressure drops and how long the reduction lasts.
Common symptoms include:
- Lightheadedness
- Dizziness
- Blurred vision
- Tunnel vision
- Feeling faint
- Weakness
- Fatigue
- Brain fog
- Difficulty concentrating
- Neck and shoulder discomfort (“coat hanger pain”)
- Unsteadiness while walking
In more severe cases, individuals may experience:
- Falls
- Syncope (fainting)
- Temporary loss of consciousness
Because symptoms often improve after sitting or lying down, many people unconsciously begin avoiding prolonged standing or situations where they fear symptoms may occur.
Orthostatic Hypotension Is Only One Type of Dysautonomia
One of the reasons dysautonomia can be confusing is that it is not a single disorder.
Instead, it describes a spectrum of conditions involving abnormal autonomic nervous system function.
Some of the more common forms include:
- Orthostatic Hypotension (OH): Blood pressure drops significantly after standing.
- Postural Orthostatic Tachycardia Syndrome (POTS): Heart rate increases excessively upon standing while blood pressure usually remains relatively stable.
- Vasovagal Syncope: A sudden reflex causes blood pressure and heart rate to fall, leading to fainting.
- Neurocardiogenic Syncope: Another form of reflex-mediated fainting with similar underlying mechanisms.
Although these disorders share overlapping symptoms, they involve different physiological mechanisms and therefore require different treatment strategies.
This is why obtaining an accurate diagnosis is so important.
Who Is Most Commonly Affected?
Orthostatic hypotension becomes more common with age, but it can occur in individuals of any age.
People at increased risk include those with:
- Parkinson’s disease
- Multiple system atrophy
- Diabetes
- Peripheral neuropathy
- Stroke
- Spinal cord injuries
- Other autonomic nervous system disorders
- Chronic dehydration
- Certain cardiovascular conditions
It may also develop as a side effect of medications used to treat:
- High blood pressure
- Depression
- Parkinson’s disease
- Enlarged prostate
- Heart disease
A comprehensive medical evaluation is essential to determine the underlying cause.
Causes of Orthostatic Hypotension
Orthostatic hypotension itself is not a disease but rather a clinical sign that the body’s blood pressure regulation system is not functioning properly.
Potential causes include:
Autonomic Nervous System Dysfunction
Damage or dysfunction affecting autonomic pathways prevents the body from responding appropriately to standing.
Dehydration
Reduced blood volume limits the body’s ability to maintain adequate blood pressure.
Medication Side Effects
Many medications intentionally lower blood pressure and may produce excessive drops when standing.
Cardiovascular Conditions
Heart rhythm abnormalities, reduced cardiac output, or structural heart disease may impair circulation.
Neurological Disorders
Several neurodegenerative disorders affect the brain regions responsible for autonomic regulation, including Parkinson’s disease, multiple system atrophy, and pure autonomic failure.
How Is Orthostatic Hypotension Diagnosed?
Diagnosis begins with a detailed medical history and physical examination.
Blood pressure and heart rate are measured while the patient is:
- Lying down
- Sitting (when appropriate)
- Standing
These measurements help determine whether abnormal blood pressure regulation is present.
Additional testing may include:
- Tilt table testing
- Comprehensive autonomic function testing
- Blood work
- Cardiac evaluation
- Neurological examination
Because multiple medical conditions can produce similar symptoms, identifying the underlying cause is just as important as recognizing the blood pressure changes themselves.
A Chiropractic Neurology Perspective
Because orthostatic hypotension is fundamentally a disorder of autonomic regulation, a thorough neurological evaluation can provide valuable information about how the nervous system is functioning.
A chiropractic neurologist may evaluate:
- Blood pressure regulation
- Heart rate responses
- Balance
- Eye movements
- Vestibular function
- Reflexes
- Coordination
- Cranial nerve function
- Sensory processing
These findings help identify neurological deficits that may be contributing to autonomic dysfunction.
Depending on the individual’s examination, treatment may include rehabilitation strategies designed to improve nervous system function through carefully selected sensory and motor stimulation.
These therapies may include:
- Vestibular rehabilitation
- Eye movement training
- Balance exercises
- Breathing exercises
- Functional neurological rehabilitation
- Graduated cardiovascular conditioning
- Sensory integration therapies
It is important to note that chiropractic neurological care does not replace medical evaluation or management. Rather, it may complement care provided by neurologists, cardiologists, primary care physicians, and other healthcare professionals as part of a comprehensive treatment plan.
Lifestyle Strategies That May Help
Treatment should always be directed at the underlying cause whenever possible. In addition, many individuals benefit from lifestyle modifications that support healthy blood pressure regulation.
Stay Well Hydrated
Maintaining adequate hydration increases blood volume and supports healthy circulation.
Increase Sodium Intake (When Appropriate)
For some individuals, increasing dietary sodium under medical supervision can help maintain blood pressure.
This recommendation should always be discussed with a healthcare provider, particularly for patients with heart disease, kidney disease, or hypertension.
Stand Up Gradually
Moving slowly from lying to sitting and then to standing gives the autonomic nervous system additional time to respond.
Compression Garments
Compression stockings or abdominal binders may reduce blood pooling in the lower extremities and abdomen.
Exercise Regularly
Appropriately prescribed exercise can improve cardiovascular conditioning, muscle pump function, and autonomic regulation.
Programs should be individualized based on the patient’s symptoms and medical history.
Avoid Prolonged Standing
If standing cannot be avoided, shifting weight, walking in place, or contracting the leg muscles may help maintain circulation.
When Should You Seek Medical Attention?
Although occasional lightheadedness can happen to anyone, persistent or severe symptoms should never be ignored.
Seek medical evaluation if you experience:
- Recurrent fainting
- Frequent falls
- Chest pain
- Shortness of breath
- New neurological symptoms
- Persistent dizziness
- Significant changes in blood pressure
These symptoms may indicate an underlying medical condition that requires prompt evaluation.
The Bottom Line
Orthostatic hypotension is far more than simply “getting dizzy when you stand up.”
It is one of the most common forms of dysautonomia and reflects dysfunction in the autonomic nervous system’s ability to regulate blood pressure against the constant force of gravity.
For some individuals, the cause may be temporary dehydration or medication side effects.
For others, it may be an early sign of an underlying neurological or autonomic disorder.
The encouraging news is that many patients improve significantly once the underlying cause is identified and appropriate treatment is initiated.
Whether that treatment involves lifestyle changes, medical management, neurological rehabilitation, or a combination of approaches, an accurate diagnosis is the foundation of successful care.
Understanding how the brain, heart, blood vessels, and autonomic nervous system work together allows both patients and healthcare providers to move beyond simply managing symptoms and toward improving long-term function and quality of life.
If you or someone you love is suffering from dizziness and you would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic Neurology Center today. We look forward to hearing from you.
Written by Sophie Hose, DC, MS, DACNB, CCSP
Peer-Reviewed References
- Freeman R, Wieling W, Axelrod FB, et al. Consensus Statement on the Definition of Orthostatic Hypotension, Neurally Mediated Syncope and the Postural Tachycardia Syndrome. Clinical Autonomic Research. 2011.
- Fanciulli A, Jordan J, Biaggioni I, et al. Consensus Statement on the Definition of Neurogenic Orthostatic Hypotension. Clinical Autonomic Research. 2018.
- Kaufmann H, Norcliffe-Kaufmann L, Palma JA. Baroreflex Dysfunction. New England Journal of Medicine. 2020.
- Freeman R. Neurogenic Orthostatic Hypotension. New England Journal of Medicine. 2008.
- Arnold AC, Shibao C. Current Concepts in Orthostatic Hypotension Management. Current Hypertension Reports. 2013.