Explaining Coat Hanger Pain

Medically reviewed by Oluseun Olufade, MD

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 with orthostatic 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 the autonomic 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.

<p>Westend61 / Getty Images</p>

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 in postural 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.

Some researchers believe that coat hanger pain is related to problems with circulation. For example, it could be caused by occipital ischemia, or reduced blood flow in the back of the head. When people with POTS and other autonomic disorders stand up quickly from lying down, they may experience decreased blood flow between the heart and the brain. This may also lead to a reduced amount of blood flow (hypoperfusion) in the neck and shoulders.

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:

  • Applying heat and ice

  • Massage

  • Postural changes

  • Increasing salt and fluid intake

  • Relaxation techniques

  • Wearing compression socks

Heat and Ice

Applying heat (such as with heating pads or 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.


People with coat hanger pain may benefit from massage, either self-massage or massage therapy from 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 your orthostatic tolerance, the body’s ability to adjust to a standing position. This may lessen coat hanger pain over time.

Salt and Fluid Intake

Relieving orthostatic hypotension and coat hanger pain often relies on treating underlying conditions, such as POTS. Many people with POTS prevent episodes from flaring by increasing their intake of sodium (salt) and fluids. Typically, you should try to drink around 2 liters of water per day.

Compression Socks

Many people with orthostatic hypotension wear compression 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, a physical therapist can 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.

Others are prescribed Orvaten or ProAmatine (midodrine), which prevents low blood pressure and dizziness by constricting (tightening up) the blood vessels.

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 a TENS unit on 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.

Medicines that may be prescribed to reduce pain caused by POTS and related disorders include:

  • Neurontin (gabapentin), an antiepileptic drug also used to treat nerve pain

  • Elavil (amitriptyline), a tricyclic antidepressant (TCA) that also relieves neuropathic pain, tension headaches, and migraines

  • Catapres (clonidine), a drug that lowers blood pressure and helps to manage chronic 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:

  • Be ready to rate your pain from 1 to 10 on the pain intensity scale.

  • Describe when your pain gets worse and, if anything, what provides relief.

  • Explain how your coat hanger pain affects your day-to-day life: Does it interfere with your ability to perform well at work or school? Do you have trouble bending, sitting, walking, or standing? Do you avoid certain activities because of your symptoms?

  • Bring your medical history and any testing records, if available.

  • Be prepared to ask for a second opinion or referral if necessary.


Coat hanger pain radiates along the back of the neck, head, and shoulders. It’s often caused by autonomic disorders, such as postural orthostatic tachycardia syndrome (POTS), and orthostatic hypotension (a drop in blood pressure upon standing up).

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.

Read the original article on Verywell Health.