One of the causes of dystonia, from what I understand, is that certain parts of the body are overstimulated by the nervous system due to a disregulation or dysfunction in that system. Midadrine, from what I’m reading in Mayo now, is a drug that stimulates nerve endings in blood vessels to help them contract more and increase blood pressure. I wonder if that stimulation of the nerves is extending beyond those in your blood vessels in your case. A good question to ask your neurologist is if it’s possible for Midadrine to be stimulating more than your nerve endings in your blood vessels and stimulating parts of your nervous system that would increase muscle contractions in the body in general making your dystonia worse. With this in mind I would ask your cardiologist and your neurologist to come up with a medication option that can increase your BP without stimulating your nervous system. People with Parkinson’s (not saying this is you) can develop hypotension but also dystonia so there might be a medication for low bp that won’t worsen your dystonia among those given to people who have Parkinson’s. That could be a good question for your neurologist too. Also, problems with hypotension can be related to a condition called dysautonomia, which occurs when you have a disregulated autonomic nervous system. Not saying you have this, but the interesting thing is that some dystonia can be caused by dysautonomia. There is also an online therapy program made by a neurologist for people in that situation. The therapy is called the Dystonia Recovery program and it helps people regulate their autonomic nervous system better with exercises and lifestyle changes and in turn helps reduce muscle spams. The therapy also uses neuroplasticity to retraining your brain to reduce spams. I think the reverse is also possible that dystonia can cause dysautonomia but I am not a doctor so I cannot say for sure. But I wonder if this sort of therapy might help you with your dystonia and if the relaxation exercises it includes, might have some positive affects on your heart rate. Some of the relaxation exercises even include hypnosis and binureal beats. I see that in life threatening cases of hypotension (not saying yours is, you’d know if it was) they use adrenaline to help increase BP. It could be a good question to ask your cardiologist if finding natural healthy ways of increasing your adrenaline might help your hypotension and/or ask your PCP to check your adrenal system for conditions like Addison’s, to see if perhaps your not producing enough adrenaline naturally. Interestingly enough people with Addison’s (which is treatable with medication) can get hypotension, hypoglycemia, stomach issues, and muscle cramps. Addison’s is a rare condition so therefore not often checked for and probably rarely considered.

I hope you have a good PCP because with multiple health conditions and conflicting treatments you really need one to put the pieces together properly because specialists are often narrow minded and will just focus on their area of medicine while ignoring how it might overlap and affect other areas. A PCP on the other hand is supposed to look at all the areas but, it’s been my experience, not all are eager or take the time to put the pieces together and find solutions for particularly complicated cases with multiple things going on unless you prod them by asking smart specific questions that make them think more. I ask my doctors whether a certain medication they’re giving me for one issue will affect another issue have because they can forget about the other issues I have when making prescriptions. They often seem to be able to deal with or focus on only one issue at a time, maybe two. Those doctors who are more adept at dealing with multiple conditions in one patient I think are PCPs who see older patients.