Table of ContentsView AllTable of ContentsIn POTSHow it FeelsManaging Pain at HomeSpecialist TreatmentMedicationSeeking Medical Care
Table of ContentsView All
View All
Table of Contents
In POTS
How it Feels
Managing Pain at Home
Specialist Treatment
Medication
Seeking Medical Care
Coat hanger pain is tension, stiffness, and/or aching pain in the back of the neck, shoulders, and upper back that may also radiate up to the back of the head.
This type of pain is often associated withorthostatic hypotension, also known as postural hypotension. This is an extreme drop in blood pressure that happens when you move from lying down to sitting up or standing. This typically occurs due to problems with theautonomic nervous system.
This article will review everything you need to know about coat hanger pain, from common causes and risk factors to pain management options.
What Is the Autonomic Nervous System?The autonomic nervous system controls autonomic responses, which are involuntary changes like sweating, heart rate, sexual arousal, and blood pressure.
What Is the Autonomic Nervous System?
The autonomic nervous system controls autonomic responses, which are involuntary changes like sweating, heart rate, sexual arousal, and blood pressure.
Westend61 / Getty Images
Coat Hanger Pain in POTS
Many people experience coat hanger pain and orthostatic hypotension due to autonomic dysfunction (dysautonomia). This involves problems with the body’s ability to regulate involuntary functions, from hormone levels to digestive processes to heart rate to saliva production.
Autonomic dysfunction plays a key role inpostural orthostatic tachycardia syndrome(POTS), one of the most common causes of coat hanger pain. The main symptom of POTS is orthostatic intolerance, which occurs when too little blood flows to the heart when you go from a supine (lying down or prone) position to an upright one. This leads to a rapid heart rate, dizziness, and sometimes fainting. Some people with POTS also experience coat hanger pain that gets worse when they stand up.
Other autonomic nervous system disorders that can cause coat hanger pain include:
Theories About Causes
It’s not entirely clear why autonomic dysfunction and orthostatic hypotension can lead to head and neck pain.
Other researchers argue that coat hanger pain is related to muscle tension. People with autonomic dysfunction may unconsciously adopt different postures to cope with their symptoms, which could cause chronic pain in the head and neck area.
Other Associated Risk Factors
You may have a higher risk for orthostatic hypotension and/or coat hanger pain if you have:
People with POTS are more likely to experience episodes or flare-ups of coat hanger pain just before their menstrual periods, during pregnancy, or when they’re sick. Surgery and trauma can also lead to increased symptoms. While anyone can get POTS, it’s most common among women under age 50.
How Coat Hanger Pain Feels
Coat hanger pain is so named because of the way the pain radiates—from the back of the neck to both shoulders and, often, to the back of the head—like the shape of a coat hanger. It may feel like a nagging cramp, tense knot, or dull ache. It often worsens when standing or sitting in an upright position.
Many people with coat hanger pain feel like their neck is stiff and may have trouble turning their head. Your range of motion in your shoulders may also be reduced.
Managing Coat Hanger Pain at Home
There are many ways to relieve symptoms of coat hanger pain at home, including:
Heat and Ice
Applying heat (such as withheating padsor wraps) or cold (such as ice packs) to the affected area may help to relieve neck and shoulder pain. Heating pads improve blood flow in the area placed, which can help with tissue repair. However, if your coat hanger pain is due to POTS, you should avoid taking hot baths or showers as they can make symptoms worse.
Massage
People with coat hanger pain may benefit from massage, either self-massage ormassage therapyfrom a licensed practitioner. Devices like a massage cane, foam roller, or ball may also work to soothe your aching neck and shoulders. Massage can also help with migraines and tension headaches that often accompany coat hanger pain.
Changing Positions
If you have acute coat hanger pain, lying down often provides quick relief. Sleeping with your head elevated can also help to build up yourorthostatic tolerance, the body’s ability to adjust to a standing position. This may lessen coat hanger pain over time.
Salt and Fluid Intake
Compression Socks
Many people with orthostatic hypotension wearcompression socks, stockings, or hose—as well as abdominal binders—to manage their symptoms. Compression stockings improve blood flow throughout the body and prevent blood from pooling. This can improve blood pressure, prevent swelling, and soothe related symptoms, such as coat hanger pain.
Relaxation Exercises
Because muscle tension may be related to coat hanger pain, relaxation exercises and mindfulness techniques might be effective in treating it. Guided meditation,deep breathing exercises, and targeted practices aimed at releasing muscle tension have been found to be helpful in relieving chronic neck pain.
Specialist Treatment for Coat Hanger Pain
If you don’t find pain relief with at-home techniques, you may need treatment from a specialist. Available treatment options for coat hanger pain including physical therapy, exercise programs, prescription medications, and transcutaneous electrical nerve stimulation (TENS) therapy.
Physical Therapy and Exercise
Whether through manual (hands-on) therapy, education about safer postures and positioning, or guided exercise programs, aphysical therapistcan provide targeted help for your coat hanger pain. Your provider may suggest that you perform exercises in a reclined or sitting position (such as with a recumbent bicycle vs. a standard one) to avoid making your symptoms worse.
It’s also important to get plenty of rest and avoid overexerting yourself if you have POTS or another condition involving autonomic dysfunction. Still, it’s crucial to incorporate movement into your day. Avoiding all physical activity can cause deconditioning, which may exacerbate your symptoms.
Prescription Medications
Your healthcare provider may recommend that you take medication to control your orthostatic hypotension.Many people with POTS and related disorders take Florinef (fludrocortisone), a corticosteroid that helps to regulate your body’s balance of fluids and sodium.
Transcutaneous Electrical Nerve Stimulation
A physical therapist or other healthcare provider may suggest TENS, a form of therapy that blocks pain receptors using a mild electrical current. This may help to jump-start your body’s natural painkillers. Research indicates that using aTENS uniton an ongoing basis can help to curb chronic neck pain and improve range of motion.
Coat Hanger Pain Medications
Many people take over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advid or Motrin (ibuprofen), to relieve coat hanger pain.
How to Talk to a Provider About Coat Hanger Pain
It can sometimes be difficult to talk to a healthcare provider about coat hanger pain (or any pain). You may be worried that they won’t hear your concerns or take your symptoms seriously.
Here are a few things you can do to prepare for your appointment:
Summary
At-home remedies for coat hanger pain include heat, ice, massage, rest, changing positions, relaxation techniques, increasing salt and fluid intake, and putting on compression stockings. A specialist may also recommend guided exercises, physical therapy, or a TENS unit. Your healthcare provider might prescribe medication for pain or to treat the underlying cause of your symptoms.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wieling W, Kaufmann H, Claydon VE, et al.Diagnosis and treatment of orthostatic hypotension.Lancet Neurol. 2022;21(8):735-746. doi:10.1016/S1474-4422(22)00169-7MedlinePlus Genetics.Orthostatic hypotension.American Psychological Association.Autonomic nervous system.Khatri P, Panth H, Khadka S, et al.Pure autonomic failure: A case report of recurrent orthostatic hypotension.JNMA J Nepal Med Assoc. 2021;59(238):589-592. doi:10.31729/jnma.6480Go S, Yamanaka G, Kasuga A, et al.Orthostatic headache in children including postural tachycardia syndrome and orthostatic hypotension: A near-infrared spectroscopy study.J Clin Med. 2020;9(12):4125. doi:10.3390/jcm9124125MedlinePlus.Autonomic nervous system disorders.Goldstein DS, Cheshire WP Jr.The autonomic medical history.Clin Auton Res. 2017;27(4):223-233. doi:10.1007/s10286-017-0425-7National Institute of Neurological Disorders and Stroke.Postural tachycardia syndrome (POTS).Malanga GA, Yan N, Stark J.Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury.Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719de Almeida Tolentino G, Lima Florencio L, Ferreira Pinheiro C, et al.Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: A study protocol for a randomized clinical trial.BMC Neurol. 2021;21(1):249. doi:10.1186/s12883-021-02290-wPach D, Blödt S, Wang J, Keller T, et al.App-based relaxation exercises for patients with chronic neck pain: Pragmatic randomized trial.JMIR Mhealth Uhealth. 2022;10(1):e31482. doi:10.2196/31482Palma JA, Kaufmann H.Management of orthostatic hypotension.Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816Fu Q, Levine BD.Exercise and non-pharmacological treatment of POTS.Auton Neurosci. 2018;215:20-27. doi:10.1016/j.autneu.2018.07.001Buhmann C, Kassubek J, Jost WH.Management of pain in Parkinson’s disease.J Parkinsons Dis. 2020;10(s1):S37-S48. doi:10.3233/JPD-202069MedlinePlus.Fludrocortisone acetate.MedlinePlus.Midodrine.G A, Gupta AK, Kumar D, et al.Efficacy of dry needling versus transcutaneous electrical nerve stimulation in patients with neck pain due to myofascial trigger points: A randomized controlled trial.Cureus. 2023;15(3):e36473. doi:10.7759/cureus.36473Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE.Pain management in pediatric patients with postural orthostatic tachycardia syndrome: Current insights.J Pain Res. 2019;12:2969-2980. doi:10.2147/JPR.S194391U.S. Pain Foundation.How to talk about pain so your doctor will listen.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wieling W, Kaufmann H, Claydon VE, et al.Diagnosis and treatment of orthostatic hypotension.Lancet Neurol. 2022;21(8):735-746. doi:10.1016/S1474-4422(22)00169-7MedlinePlus Genetics.Orthostatic hypotension.American Psychological Association.Autonomic nervous system.Khatri P, Panth H, Khadka S, et al.Pure autonomic failure: A case report of recurrent orthostatic hypotension.JNMA J Nepal Med Assoc. 2021;59(238):589-592. doi:10.31729/jnma.6480Go S, Yamanaka G, Kasuga A, et al.Orthostatic headache in children including postural tachycardia syndrome and orthostatic hypotension: A near-infrared spectroscopy study.J Clin Med. 2020;9(12):4125. doi:10.3390/jcm9124125MedlinePlus.Autonomic nervous system disorders.Goldstein DS, Cheshire WP Jr.The autonomic medical history.Clin Auton Res. 2017;27(4):223-233. doi:10.1007/s10286-017-0425-7National Institute of Neurological Disorders and Stroke.Postural tachycardia syndrome (POTS).Malanga GA, Yan N, Stark J.Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury.Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719de Almeida Tolentino G, Lima Florencio L, Ferreira Pinheiro C, et al.Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: A study protocol for a randomized clinical trial.BMC Neurol. 2021;21(1):249. doi:10.1186/s12883-021-02290-wPach D, Blödt S, Wang J, Keller T, et al.App-based relaxation exercises for patients with chronic neck pain: Pragmatic randomized trial.JMIR Mhealth Uhealth. 2022;10(1):e31482. doi:10.2196/31482Palma JA, Kaufmann H.Management of orthostatic hypotension.Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816Fu Q, Levine BD.Exercise and non-pharmacological treatment of POTS.Auton Neurosci. 2018;215:20-27. doi:10.1016/j.autneu.2018.07.001Buhmann C, Kassubek J, Jost WH.Management of pain in Parkinson’s disease.J Parkinsons Dis. 2020;10(s1):S37-S48. doi:10.3233/JPD-202069MedlinePlus.Fludrocortisone acetate.MedlinePlus.Midodrine.G A, Gupta AK, Kumar D, et al.Efficacy of dry needling versus transcutaneous electrical nerve stimulation in patients with neck pain due to myofascial trigger points: A randomized controlled trial.Cureus. 2023;15(3):e36473. doi:10.7759/cureus.36473Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE.Pain management in pediatric patients with postural orthostatic tachycardia syndrome: Current insights.J Pain Res. 2019;12:2969-2980. doi:10.2147/JPR.S194391U.S. Pain Foundation.How to talk about pain so your doctor will listen.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Wieling W, Kaufmann H, Claydon VE, et al.Diagnosis and treatment of orthostatic hypotension.Lancet Neurol. 2022;21(8):735-746. doi:10.1016/S1474-4422(22)00169-7MedlinePlus Genetics.Orthostatic hypotension.American Psychological Association.Autonomic nervous system.Khatri P, Panth H, Khadka S, et al.Pure autonomic failure: A case report of recurrent orthostatic hypotension.JNMA J Nepal Med Assoc. 2021;59(238):589-592. doi:10.31729/jnma.6480Go S, Yamanaka G, Kasuga A, et al.Orthostatic headache in children including postural tachycardia syndrome and orthostatic hypotension: A near-infrared spectroscopy study.J Clin Med. 2020;9(12):4125. doi:10.3390/jcm9124125MedlinePlus.Autonomic nervous system disorders.Goldstein DS, Cheshire WP Jr.The autonomic medical history.Clin Auton Res. 2017;27(4):223-233. doi:10.1007/s10286-017-0425-7National Institute of Neurological Disorders and Stroke.Postural tachycardia syndrome (POTS).Malanga GA, Yan N, Stark J.Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury.Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719de Almeida Tolentino G, Lima Florencio L, Ferreira Pinheiro C, et al.Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: A study protocol for a randomized clinical trial.BMC Neurol. 2021;21(1):249. doi:10.1186/s12883-021-02290-wPach D, Blödt S, Wang J, Keller T, et al.App-based relaxation exercises for patients with chronic neck pain: Pragmatic randomized trial.JMIR Mhealth Uhealth. 2022;10(1):e31482. doi:10.2196/31482Palma JA, Kaufmann H.Management of orthostatic hypotension.Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816Fu Q, Levine BD.Exercise and non-pharmacological treatment of POTS.Auton Neurosci. 2018;215:20-27. doi:10.1016/j.autneu.2018.07.001Buhmann C, Kassubek J, Jost WH.Management of pain in Parkinson’s disease.J Parkinsons Dis. 2020;10(s1):S37-S48. doi:10.3233/JPD-202069MedlinePlus.Fludrocortisone acetate.MedlinePlus.Midodrine.G A, Gupta AK, Kumar D, et al.Efficacy of dry needling versus transcutaneous electrical nerve stimulation in patients with neck pain due to myofascial trigger points: A randomized controlled trial.Cureus. 2023;15(3):e36473. doi:10.7759/cureus.36473Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE.Pain management in pediatric patients with postural orthostatic tachycardia syndrome: Current insights.J Pain Res. 2019;12:2969-2980. doi:10.2147/JPR.S194391U.S. Pain Foundation.How to talk about pain so your doctor will listen.
Wieling W, Kaufmann H, Claydon VE, et al.Diagnosis and treatment of orthostatic hypotension.Lancet Neurol. 2022;21(8):735-746. doi:10.1016/S1474-4422(22)00169-7
MedlinePlus Genetics.Orthostatic hypotension.
American Psychological Association.Autonomic nervous system.
Khatri P, Panth H, Khadka S, et al.Pure autonomic failure: A case report of recurrent orthostatic hypotension.JNMA J Nepal Med Assoc. 2021;59(238):589-592. doi:10.31729/jnma.6480
Go S, Yamanaka G, Kasuga A, et al.Orthostatic headache in children including postural tachycardia syndrome and orthostatic hypotension: A near-infrared spectroscopy study.J Clin Med. 2020;9(12):4125. doi:10.3390/jcm9124125
MedlinePlus.Autonomic nervous system disorders.
Goldstein DS, Cheshire WP Jr.The autonomic medical history.Clin Auton Res. 2017;27(4):223-233. doi:10.1007/s10286-017-0425-7
National Institute of Neurological Disorders and Stroke.Postural tachycardia syndrome (POTS).
Malanga GA, Yan N, Stark J.Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury.Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719
de Almeida Tolentino G, Lima Florencio L, Ferreira Pinheiro C, et al.Effects of combining manual therapy, neck muscle exercises, and therapeutic pain neuroscience education in patients with migraine: A study protocol for a randomized clinical trial.BMC Neurol. 2021;21(1):249. doi:10.1186/s12883-021-02290-w
Pach D, Blödt S, Wang J, Keller T, et al.App-based relaxation exercises for patients with chronic neck pain: Pragmatic randomized trial.JMIR Mhealth Uhealth. 2022;10(1):e31482. doi:10.2196/31482
Palma JA, Kaufmann H.Management of orthostatic hypotension.Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816
Fu Q, Levine BD.Exercise and non-pharmacological treatment of POTS.Auton Neurosci. 2018;215:20-27. doi:10.1016/j.autneu.2018.07.001
Buhmann C, Kassubek J, Jost WH.Management of pain in Parkinson’s disease.J Parkinsons Dis. 2020;10(s1):S37-S48. doi:10.3233/JPD-202069
MedlinePlus.Fludrocortisone acetate.
MedlinePlus.Midodrine.
G A, Gupta AK, Kumar D, et al.Efficacy of dry needling versus transcutaneous electrical nerve stimulation in patients with neck pain due to myofascial trigger points: A randomized controlled trial.Cureus. 2023;15(3):e36473. doi:10.7759/cureus.36473
Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE.Pain management in pediatric patients with postural orthostatic tachycardia syndrome: Current insights.J Pain Res. 2019;12:2969-2980. doi:10.2147/JPR.S194391
U.S. Pain Foundation.How to talk about pain so your doctor will listen.
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