While many people with Parkinson’s Disease recognize tremors, stiffness, and slowed movement as common signs of Parkinson’s disease, fewer are aware of non-motor symptoms that can significantly affect daily life. One of these is neurogenic orthostatic hypotension (nOH), a condition that can cause dizziness, lightheadedness, and even fainting when standing up or change of body positioning.

What Is Parkinson’s Disease?

Parkinson’s disease is a progressive neurological disorder that affects the brain’s ability to control movement. It develops when nerve cells that produce dopamine gradually become damaged or die. In addition to movement-related symptoms, Parkinson’s disease can also affect sleep, mood, digestion, and the autonomic nervous system. The automatic nervous system includes the non-conscious control of our heart rate and blood pressure. Parkinson’s Disease may lead to improper control of the body’s autonomic nervous system causing neurogenic orthostatic hypotension. 

What Is Neurogenic Orthostatic Hypotension?

Neurogenic orthostatic hypotension is a form of low blood pressure that occurs when standing up. Episodes can also occur when moving from laying flat to sitting up. In healthy individuals, the autonomic nervous system quickly adjusts blood pressure to maintain blood flow to the brain. In people with nOH, these automatic adjustments do not work properly because of nerve damage in the brain due to Parkinson’s Disease. 

As a result, blood pressure drops significantly upon standing, reducing blood flow to the brain and causing symptoms such as:

• Dizziness or lightheadedness
• Blurred vision
• Weakness or fatigue
• Difficulty concentrating
• Feeling like you might faint
• Fainting (syncope)

How Are Parkinson’s Disease and nOH Connected?

Parkinson’s disease can damage the autonomic nervous system, making it difficult for the body to regulate blood pressure. Some medications used to treat Parkinson’s symptoms may also contribute to lower blood pressure. Because of this, nOH is relatively common among people living with Parkinson’s disease. Awareness of nOH can help with fall prevention, injuries, and overall improved quality of life. 

Managing Neurogenic Orthostatic Hypotension

Treatment for nOH often includes a combination of lifestyle changes and, when appropriate, medication. Healthcare providers may recommend:

• Standing up slowly from sitting or lying down
• Ensure your head is last thing to come upright when standing up to reduce dizziness and lightheadedness
• Drinking enough fluids and staying well hydrated
• Increasing salt intake if recommended by a healthcare provider
• Wearing compression stockings or an abdominal binder
• Elevating the head of the bed while sleeping
• Reviewing medications that may contribute to low blood pressure
• Prescription medications specifically approved to treat nOH when needed
• Management upon waking up: Move from lying to sitting, pause, and then stand slowly. Keep head down slightly and let it be the last part of your body to come up to optimize symptom management 
• If you do get a dizzy or lightheaded, take a seat and allow your body to adjust up to 5 minutes prior to attempting to stand again 

Management should always be individualized under the guidance of a healthcare professional.