Hanger pain is pain, stiffness, or tension in the back of the neck, shoulders, and upper back—the part of the body that resembles a hanger. This pain is often associated with disorders of the autonomic nervous system, which affect blood flow and blood pressure.
Although hanger pain may initially seem like a minor muscle ache or cramp, it is often a sign of an underlying condition that requires diagnosis and treatment. A visit to the doctor is important to address the pain and its cause so that you can get the proper care and relief.
Hanger pain affects the upper back, shoulders and neck, forming a pattern that mimics the shape of a hanger. The discomfort may feel like tension or tightness in the neck and upper back muscles.
Hanger’s pain can also feel like a charley horse, which is muscle spasms and cramps that get worse when you stand for long periods of time, lift objects like grocery bags, turn your head, or get up from a sitting position.
Hanger pain can range from mild, occasional discomfort to debilitating episodes of pain that interfere with daily tasks. Understanding the causes and possible triggers of hanger pain is the first step in finding an effective treatment.
Several conditions can cause hanger pain. Most of these conditions are associated with postural hypotension or orthostatic hypotension, a sudden drop in blood pressure when moving from lying down to sitting or standing.
Postural hypotension is a sign of autonomic nervous system (ANS) dysfunction. The ANS regulates involuntary bodily functions, such as blood pressure, heart rate, body temperature, and digestion. A malfunctioning ANS can disrupt normal blood flow to the upper body, leading to muscle tension and hangover pain.
Postural Orthostatic Tachycardia Syndrome (POTS)
One of the leading causes of hanger pain is postural orthostatic tachycardia syndrome (POTS), an autonomic nervous system disorder that affects multiple organs and bodily functions. The primary symptom of POTS is a rapid heartbeat when standing or sitting after lying down.
In POTS, dysfunction of the ANS affects blood vessel function. Normally, blood vessels constrict when you stand to prevent blood from pooling in your lower body. In people with POTS, blood vessels do not constrict when standing, resulting in reduced blood flow to the upper body.
Reduced circulation means that the muscles of the neck, shoulders and back do not receive enough oxygen-rich blood, leading to muscle aches and tension in the form of hanger-on pain.
POTS can cause other symptoms such as:
- Dizziness or vertigo
- Headaches or migraines
- Brain fog
- Problems finding words while speaking
- Difficulty with depth perception
- Pins and needles sensation
Ehlers-Danlos syndrome
Ehlers-Danlos syndrome (EDS) is a group of 13 inherited disorders that affect the body’s connective tissue, including the skin, joints and blood vessel walls. Although each type of EDS causes different symptoms, people with EDS often experience symptoms such as:
- Hypermobility of joints
- Chronic pain
- Stretchable leather
- Fatigue
Hypermobility of connective tissue and joints can cause instability of the cervix (neck), neck and shoulder muscle strain. This affects the function of the nerves and blood vessels in the upper body, leading to hanger pain.
Neurally mediated syncope (NMS)
Neurally mediated syncope (NMS) is a chronic condition in which the body experiences a sudden drop in blood pressure and heart rate (bradycardia) when standing, leading to dizziness or loss of consciousness (syncope).
In NMS, dysfunction of the autonomic nervous system affects how the brain sends signals to the blood vessels or how the blood vessels respond to those signals, interfering with normal blood flow to the upper body. Insufficient blood flow can prevent the muscles of the neck, shoulders and upper back from receiving oxygen and nutrient-rich blood, which can cause muscle tension and pain.
Emotional stress, dehydration, prolonged standing, high temperatures and crowding can cause pain and other symptoms of NMS, such as:
- Dizziness or vertigo
- Fatigue when standing
- Difficulty walking
- Blurred vision
- Brain fog
- Feeling faint
- Shortness of breath
Multiple System Atrophy (MSA)
Multiple system atrophy (MSA) is a rare progressive neurodegenerative disorder that affects both the autonomic nervous system (which controls involuntary body functions) and the central nervous system (which controls motor functions, such as movement).
MSA causes the death and loss of function of nerve cells in the brain and spinal cord, leading to symptoms such as stiffness, tremors, slow movements and lack of coordination.
MSA causes dysfunction of the ANS, which causes a sudden drop in blood pressure when standing and contributes to hanger pain. It can also cause stiffness, stiffness and tension in the neck and shoulder muscles.
Pure Autonomic Failure (PAF)
Pure autonomic failure (PAF) is a rare neurodegenerative condition affecting the autonomic nervous system. Causes chronic postural hypotension.
Unlike other neurodegenerative diseases, PAF does not usually affect movement, but it disrupts the body’s ability to regulate blood pressure, leading to symptoms such as lightheadedness, dizziness, and hangover pain.
People with PAF may also experience other symptoms associated with ANS dysfunction, including:
- Dizziness and vertigo
- Vision disorders, such as tunnel vision
- Shortness of breath
- Anhidrosis (lack of sweating)
- Prison
- Painful urination
Parkinson’s disease
Parkinson’s disease is a chronic, progressive neurodegenerative disorder that affects neurons in the brain that produce dopamine, leading to movement problems, including tremors, muscle stiffness and rigidity, slow movements, and balance problems.
Several factors can contribute to hanger pain in people with Parkinson’s disease. Stiffness and postural instability (problems with gait and balance) can strain neck and shoulder muscles, leading to muscle tension and pain.
Parkinson’s disease and some treatments for Parkinson’s disease can cause sudden drops in blood pressure, which also lead to hangover pain.
Figuring out if you’re experiencing hanger pain and not muscle strain from overuse or injury can sometimes be a challenge. A classic sign of hanger pain is that the pain improves when lying down, while a muscle strain from overuse or injury may continue to hurt even when resting.
Most causes of pelvic pain are chronic conditions that require medical diagnosis and ongoing treatment, so it’s important to see a doctor if you experience recurring, persistent, or severe pelvic pain.
See your healthcare provider as soon as possible if you experience pelvic pain with any of the following symptoms:
- Dizziness, lightheadedness, or fainting when you get up from sitting or lying down
- The vision is changing
- Changes in your mobility, such as difficulty keeping your balance or walking
- Tremor
- Shortness of breath
To diagnose the cause of hanger pain, a health care provider will likely begin by reviewing your medical history and symptoms. Because hanger pain is often associated with autonomic dysfunction or blood pressure problems, you may be referred to a specialist, such as a neurologist or cardiologist (doctors who specialize in diagnosing and treating disorders of the brain and nervous system and conditions of the heart and blood vessels, respectively).
Your health care provider will want to know if you have other symptoms in addition to hanger pain, such as dizziness, headache, or a slow heart rate. They may also ask if specific triggers, such as sitting after lying down, hot baths, dehydration, or emotional stress, cause or worsen your pain.
During a physical exam, your doctor may measure your blood pressure and heart rate while lying down and then again while standing or sitting for 1-3 minutes. They may also examine your neck, shoulders, and upper back for tenderness, swelling, or muscle weakness.
Diagnostic tests
Diagnostic tests can help identify the underlying cause of pelvic pain. This includes:
- Blood tests: They can check for metabolic or hormonal imbalances that can cause symptoms similar to those of conditions associated with hanger pain.
- Neurological examination: If your doctor suspects that your hanger pain may be due to a neurological or neurodegenerative condition, he may perform a neurological exam to assess muscle strength, coordination, and reflexes.
- Autonomic function tests: Certain tests can assess how well your autonomic nervous system regulates your blood pressure and heart rate. This involves a tilt test, where you lie on a table that is slowly adjusted upwards. As your position changes, the provider can monitor how your heart rate and blood pressure respond.
- Imaging tests: Your provider may order an ultrasound or other imaging tests to examine the spinal cord, brain, or internal organs to check for abnormalities.
Treatment for hanger pain depends on the underlying cause. It may include home treatments to relieve pain and discomfort and medications or therapies to address the underlying cause of your pain.
Treatments at home
There are several ways to relieve hangover pain from the comfort of your own home, including:
- Position changes: Hanger pain is often worse when you stand, especially for long periods of time. Before the pain worsens, lie flat on your back to allow the muscles to relax and improve circulation.
- Stay hydrated: Drink fluids throughout the day, including water or electrolyte drinks, to prevent dehydration. Drinking a bottle of water a minute or two before getting out of bed can also help reduce symptoms.
- Flexible leg muscles: Pumping your ankles or tightening your leg muscles about 10 times before standing can constrict blood vessels and encourage blood flow to your upper body when you stand.
- Heat therapy: Applying a heating pad or hot pack to the neck, shoulders and upper back can stimulate blood flow to the area and relieve pain.
- Non-prescription drugs: Pain relievers such as Tylenol (acetaminophen) and Advil (ibuprofen) can reduce mild to moderate muscle pain.
- Compression garments: Wearing compression stockings or abdominal compression garments can help improve blood flow and reduce symptoms of orthostatic hypotension, reducing hanger pain.
Medical treatments
Some causes of hanger pain require ongoing treatment with medication or therapy, which can help manage hanger pain. Your healthcare provider may recommend one or more of the following to manage hanger pain:
- Prescription drugs: Medications such as Florinef (fludrocortisone) can help the body regulate sodium and fluid balance to manage orthostatic hypotension. ProAmatine and Orvaten (midodrine) help tighten blood vessels to prevent low blood pressure and improve circulation. Elavil (amitriptyline) is an antidepressant that relieves tension headaches, migraines, and neuropathic (nerve) pain.
- physical therapy: A physical therapist can develop a treatment plan to strengthen neck and shoulder muscles and improve posture to manage hanger pain.
- Transcutaneous nerve stimulation (TENS): TENS units use low-voltage electrical currents to stimulate nerves and reduce pain signals. Placing TENS electrodes on the neck, shoulders, or upper back for hangover pain can help relax tight muscles and relieve pain.
Hanger pain is associated with orthostatic hypotension and conditions affecting the autonomic nervous system, causing discomfort in the neck, shoulders, and upper back. If your pain improves when you lie down, it could be a sign of hanger pain.
See a doctor if you suspect you have hanger pain, especially if you experience pain and other symptoms, such as lightheadedness or dizziness when standing, headaches, brain fog, or difficulty walking or balancing.