Positional headache: causes, symptoms and treatment (2023)

Headaches can be a symptom of a variety of medical conditions, ranging in severity from a mild annoyance to a serious health issue. If one day you wake up with a heartbeatmorning headachethat gets worse throughout the day, monitor your symptoms closely. This may be the first sign of a low-pressure headache, also known as a positional headache, which often requires medical attention.

To better see whatkind of headacheWhen experimenting, pay attention to two important clues: which behaviors trigger the pain and which behaviors, if any, relieve the pain. This can say a lot about the type of headache you have and how to treat it.

If you experience a throbbing or throbbing headache when standing or sitting,evita, or exercise and the pain lessens when lying down, it is more likely to be a positional headache.

When you suffer from positional headaches, your body's position primarily aggravates and relieves the pain. Standing and sitting upright increases the pain, while lying down reduces or eliminates it.

What is a positional headache?

A positional headache is characterized by pain in the back of your head that starts or gets worse when you're standing or sitting and improves or lessens when you're lying down (usually in 30 minutes or less).

Other names for positional headaches include:

• orthostatic headache
• postural headache
• low pressure headache

If you still have a headache after 30 minutes or so of lying down, you probably don't have positional headaches. You may be suffering from atension headache,migraine, or another common type of headache.

What causes a positional headache?

The two most common causes of orthostatic headache areCerebrospinal fluid (CSF) leak.and a condition calledOrtostatische postural tachycardia (POTS)🇧🇷 In rarer cases, a positional headache can also be the result of a number of other disorders that affect the nervous system, connective tissue, and bones.

CSF leak

Cerebrospinal fluid (CSF) surrounds your brain and spinal cord and acts as a cushion and shock absorber, protecting you from touching one of your bones when moving. Membranes called the meninges hold the CSF in place, and when these membranes are damaged, CSF can leak into the body.

A CSF leak has two main problems. First, because CSF normally surrounds the spinal cord in large amounts, standing or sitting over a leak can cause additional loss of CSF volume, leading to headaches. Lying down can help keep more cerebrospinal fluid in place around the spinal cord, thereby reducing pain.

In addition, the pressure change caused by a CSF leak affects the position of the brain, making it more likely that the brain will come into contact with sensitive parts of the head and spine.

Depending on the extent of damage to the meninges, a CSF leak can range from a minor leak to a severe leak that causes chronic pain.

Posturales orthostatisches Tachykardies syndrom (POTS)

POTS is a condition that affects the autonomic nervous system (ANS), preventing the ANS from doing its normal job of properly regulating heart function and body fluid balance.

A person with POTS often experiences spikes in heart rate when moving from a lying or sitting position to a standing position. This causes sudden symptoms of dizziness.fatigueor headache when standing up.

These symptoms may be accompanied by:

• somnolence
• difficulty breathing
• nausea and vomit
• Diarrhea
• Swelling in the lower legs and feet.

However, it's not clear what exactly causes POTS.most casesIt occurs in women between 15 and 50 years.

Other Causes of Low Pressure Headaches

While the above two conditions are the most common causes,the following health problemsit can also cause someone to develop positional headaches.

• Structural neck problems: Conditions that affect the skeletal muscles, discs, joints, nerves, blood vessels or connective tissues of the neck can cause a specific type of positional headache called a positional headache.cervicogenic headache.
• dehydration: When a person is heavydehydrated, there may be a sharp drop in blood pressure when standing up (due to a lack of body fluids), which causes headaches in the upright position.
• Anamie: Significant blood loss for any reason, including anemia, means less blood is flowing to the brain, which can cause a headache that may get worse when you stand up.
• brain tumors: Tumors can block the flow of cerebrospinal fluid to the brain, causing significant changes in cerebrospinal fluid pressure when a person changes positions from lying to standing.
• traumatic or surgical interventions: CSF leaks can occur after trauma to theKopfor neck, certain surgical procedures on the spine, or after a spinal tap (lumbar tap).

Positional headache symptoms

The main symptoms of a low-pressure headache are pain in the back of the head, which may extend to the back of the neck, and noticeable relief from this pain within 20 to 30 minutes of lying down. Typically, a positional headache involves severe pain that can feel throbbing, throbbing, sharp, or achy.

pain can betriggered or worsenedthrough the following activities:

• Pare
• Mount
• in motion
• Working
• Evita
• grab and stretch
• for% sor sneeze
• tiringsexual activity
• effort to defecate

Another common CSF lick headache symptom is a mild headache upon waking that gradually gets worse throughout the day.

Although orthostatic headaches usually cause pain that originates in the back of the head, the pain can spread to all areas of the head or even be isolated to one side.

How is a positional headache diagnosed?

When diagnosing the causes of an orthostatic headache, your doctor will likely try to rule out a CSF or POTS leak before looking for other sources of your pain. Be sure to describe to your doctor any position or activity that makes the pain go away, as these can be important clues to a diagnosis.

To test for a CSF leak and determine the location and severity of the leak, several different tests can be performed, although the most accurate non-invasive test is onebrain MRI.

If the exact location of the leak is difficult to determine, your doctor may perform an additional test calledCT cisternography🇧🇷 This requires a lumbar puncture, which injects a contrast fluid into the cerebrospinal fluid. Then, a CT scan is performed, which allows doctors to identify the source of the leak and its drainage path.

If a CSF leak is not the cause, your doctor may perform a POTS test next. To diagnose this, your doctor may ask you to attend aStehtestor a table tilt test. Both tests are designed to see if your POTS symptoms are caused by your posture.

A standing test asks you to stand for 30 minutes while your doctor checks your heart rate and blood pressure. In a tilt test, you lie strapped to a horizontal examination table, which tilts your body at various angles while your heart rate and blood pressure are closely monitored for significant increases.

Once CSF leak and POTS are ruled out, your doctor will look for less common causes such as neck problems, anemia, or brain cancer.

How to treat a positional headache

The approach to treating an orthostatic headache depends on the underlying cause. Treatments range from home remedies and lifestyle changes to medical procedures and even surgery in more severe cases.

Treatment of CSF leaks

In some cases, a slight CSF leak will resolve on its own. A person with moderate CSF leak can try the followinghome remediesTo treat symptoms of orthostatic headache:

• Rest more and keep your body in a horizontal position.
• Stay hydrated by drinking fluids
• Avoid overexertion (e.g. heavy lifting, strenuous exercise)
• He mustfor% sand sneeze as much as possible
• Drink coffee, tea, or another caffeinated beverage.
• Eat or drink ginger-based substances to help with nausea.
• Use an abdominal bandage for compression.
• Practice yoga or meditation

Symptoms of moderate CSF leaking headaches can also be treated with:

• Intravenous (IV) fluid therapy: Someone with a CSF leak may lose more fluid than the average person. A hospital can help replace these fluids through an IV, allowing important fluids to enter the bloodstream more quickly and directly.
• IV caffeine therapy: Caffeine can also be releasedintravenousin a hospital to treat headaches, especially after surgery. This can be effective as caffeine stimulates the body.central nervous system, which affects and increases blood pressure. Caffeine is also believed to help relieve headaches.constrict the blood vesselswhich increased painfully.
• Acupuncture: In some cases, acupuncture has been found to relieve pain caused byHeadache after puncture🇧🇷 A licensed acupuncturist will insert fine needles into the body at specific pressure points to accomplish this.stimulate the nervesand release hormones that can help relieve pain. Acupuncture has had mixed results, and the medical community debates its effectiveness. Talk to your doctor if you're interested in trying acupuncture to treat CSF leak headaches.

In the case of a more severe CSF leak, especially if the patient has severe or chronic postural headaches, the doctor may recommend a procedure calledepidural Blutpflaster (EBP)provide the patient with temporary relief from symptoms.

As the procedure must be performed in a medical facility and can have unpleasant side effects such as back pain, it is usually only used when other forms of treatment have been ineffective.

In an EBP procedure, 10 to 100 milliliters of the patient's own blood is injected into the epidural area of ​​the spinal canal. This serves to patch up the outer layer of the meninges, reducing the amount of CSF lost through the membrane. A doctor will perform EBP at the site of the leak or, if the exact location of the leak is unknown, near the middle or lower part of the spine.

While an EBP procedure provides immediate pain relief for most people, the effects of the patch wear off over time, so lasting relief may require ongoing procedures. It is recommended to avoid bending over and any muscle strain for 4 to 6 weeks after EBP.

In the case of a chronic or severe cerebrospinal fluid leak, the doctor may recommend different types of surgery to correct structural problems or remove abnormal growths in the spinal region.

POTS treatment

While there is no cure for POTS, in most cases the symptoms improve over time with lifestyle changes and medical treatment.

Treatment plans often include medications and home strategies to ease symptoms. As this condition affects every patient differently, a person may need to try a few different treatment methods before finding the one that is most effective for their body.

If you have POTS, your doctor may prescribe one or more of the following medications:

• fludrocortisona: this is a type of corticosteroid that helps the body retain salt and water, which are necessary for the body to function normally. POTS often prevents the body from going through its normal process of balancing body fluids, so patients may not naturally retain enough water and salt.
• rolando: this is an alpha-adrenergic agonist that constricts blood vessels, which increases blood pressure. POTS patients may be advised to take this medication daily or when they know they will be on their feet for a period of time.
• beta blockers: By preventing adrenaline from reaching the beta receptors in your body, beta blockers help lower your heart rate and blood pressure. Because POTS causes unnecessary spikes in heart rate when standing or sitting, this medication may be helpful for some patients.

• Selective serotonin reuptake inhibitors (SSRIs): These areantidepressantsThey help increase the amount of serotonin circulating in the brain, which can have a relaxing effect on certain bodily functions and can help keep heart rate and blood pressure at reasonable levels.
• salt tablets: Another way to help the body maintain essential salt levels is to take salt pills.

The main approach to treating POTS involves lifestyle changes to manage and alleviate the symptoms of this condition. Because people with POTS often have low blood volume, your doctor may recommend adding more salt to your diet and drinking more water to increase your blood volume.

Other lifestyle changes that help manage POTS include:

• Drink about 16 ounces (or two full glasses) of water before getting up
• Eat smaller meals more often to stay hydrated
• Keep a regular sleep schedule and get enough sleep
• Engage in recumbent aerobic activities such as cycling and rowing
• Add salt to the diet (previously consult your doctor)
• Symptom monitoring to identify and avoid your unique triggers

How to avoid positional headaches

There is no way to completely prevent positional headaches from developing, as they are often caused by underlying medical conditions.

However, you can reduce your risk of conditions that cause these headaches by practicing healthy lifestyle habits, such as eatingbalanced nutrition– and avoid unnecessary muscle tension.

Risk factors for developing a CSF leak include:

• Overuse or strain on muscles during physical activity
• Frequent bouts of coughing or extreme sneezing
• Participating in activities that make the body shake or shake (e.g. roller coasters)
• Undergoing certain medical procedures, such as B. a lumbar puncture
• Genetic or inherited disorders, including polycystic kidney disease
• Tumors or cysts in the head, neck and spine

there is a biggerRiskthe development of POTS in people who:

• Do you have an autoimmune disease?
• recently experiencedinfectious mononucleosis, or a severe virus or infection
• recently suffered ahead trauma
• is or was pregnant

when to the doctor

If you have unexplained, chronic, or severe headaches, make an appointment with your doctor to discuss your symptoms and rule out serious causes.

Go to the hospital or seek emergency medical help if your low pressure headache is accompanied by any of the following, as these could be warning signs of CSF or POTS leak:

• nausea and vomit
• neck pain
• Extreme sensitivity to light or noise, hearing loss or blurred vision
• imbalance
• pain between the shoulder blades
• Dizziness, dizziness or brain fog
• pain or numbness in the arms
• exhausted
• Mamillensekretion
• Sudden changes in heart rate or blood pressure when standing up
• fainting

How K Health can help

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All K Health articles are written and reviewed by an MD, PhD, NP or PharmD and are for informational purposes only. This information does not constitute professional medical advice and should not be relied upon. Always talk with your doctor about the risks and benefits of any treatment.