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An orthostatic challenge measuring heart rate and blood pressure changes before and after standing from recumbency are relatively easy to perform and is a good screening tool. If symptoms are provoked and there is a change in heart rate of greater than 30 beats per minute in adults (or 40 beats per minute in children) without a change in blood pressure 5 minutes after standing this could indicate postural tachycardia syndrome and warrants further investigation. A decrease in systolic blood pressure of greater than 20mmHg indicates orthostatic hypotension and also warrants further investigation. Autonomic dysfunction is also one cause of exercise intolerance. An exercise tolerance test performed by a qualified health professional can help identify whether autonomic dysfunction is possibly contributing to post-concussion symptoms.

Autonomic dysfunction in the setting of mTBI/concussion often responds to graded subthreshold exercise program. Specialist referral and further investigation (e.g. Tilt Table testing) is warranted if symptoms do not resolve.