As a parent, you’ve probably had more than your fair share of headaches. For example, there are pregnancy headaches, headaches caused by crying babies or older kids, frustration headaches — you name it. There’s also the inevitable headache any time kids attempt DIY activities or a crafts project using glue. Then there are the headaches you seem to notice more as you age, like those associated with hangovers, the weather, or a headache that gets worse when standing up. If you’ve experienced one in that last category, then you may have had an orthostatic headache.
Here’s what to know about orthostatic headaches, including the headache’s position and what it might have to do with a CSF leak, epidural blood patch, and postdural puncture headaches.
What is an orthostatic headache?
An orthostatic headache — also known as a positional or postural headache — gets worse within 30 seconds of standing up but typically goes away when you lie flat. It may happen every day or just on occasion. According to Science Direct, an orthostatic headache may occur alongside myriad symptoms, including pain or stiffness of the neck, nausea, vomiting, change in hearing, visual blurring, pain between the shoulder blades, and occasionally facial numbness or weakness.
The position of an orthostatic headache can vary, but they tend to cause pain in the back of the head. However, it’s also possible to experience an orthostatic headache on the front of your head, just one side of your head, or your entire head that tends to worsen throughout the day. Additionally, the pain can range from dull to severe, and in some cases, might cause throbbing, per the Mayo Clinic.
Sometimes orthostatic headaches can be confused with migraines. Migraines usually happen on one or both sides of your head and cause similar throbbing sensations. Movement can also make a migraine more painful, but light, sound, or certain smells are more common factors that make migraines worse. Some people who suffer from migraines may also experience vomiting or nausea.
Other than standing up, other activities that can make orthostatic headaches worse include:
- Coughing or sneezing
- Strenuous exercises
- Sexual activities
- Bending over
- Straining during a bowel movement
What causes an orthostatic headache?
Multiple conditions and medical complications can result in an orthostatic headache, ranging from those that are minor to those that are more severe.
Cerebrospinal fluid surrounds and cushions the brain and spinal cord — not only preventing injury but also serving as a nutrient delivery-and-waste-removal system for the brain. Sometimes, cerebrospinal fluid (CSF) may leak through a small tear or hole in the outermost layer of connective tissue surrounding the brain and spinal cord. When a CSF leak occurs, it may be accompanied by a headache because the brain is no longer cushioned as much as usual. A severe leak can cause more than just headaches. It can lead to other complications like meningitis or seizures. Some may also experience a persistent runny nose or ear drainage. If this continues, contact your doctor immediately.
CSF leaks, which are categorized as either spinal or cranial, are rare — it’s estimated that they occur in about five in every 100,000 people. They tend to be more frequent in women and people in their 30s and 40s. CSF leaks are usually caused by head injury, recent epidural, or brain or spinal surgery.
Postdural Puncture Headache
A postdural puncture headache (PDPH) results from a potential complication with a lumbar puncture, also known as a spinal tap. According to the National Institutes of Health (NIH), PDPHs are most common in women between the ages of 20 and 40. The symptoms tend to mimic those of a CSF leak, including pain that gets worse when the person is upright, nausea, neck pain, dizziness, visual changes, tinnitus, hearing loss, or radicular symptoms in the arms.
Additional causes of orthostatic headaches include:
- Severe anemia or blood loss
- Postural orthostatic tachycardia syndrome (POTS)
- Colloid cyst
- A brain tumor or metastasis
How long do orthostatic headaches last?
It truly is a toss-up. An orthostatic headache can last anywhere between five minutes to 48 hours.
What is the treatment for an orthostatic headache?
If you go to the doctor and they suspect that the cause of your orthostatic headache is something more serious — like a CSF leak or tumor — they’ll likely make the diagnosis using imaging techniques like an MRI scan or a myelogram.
The treatment for an orthostatic headache largely depends on its root cause. The first course of treatment for CSF leaks is bed rest, hydration, intravenous caffeine infusions, and saline infusions. For spinal CSF leaks that don’t improve after the first round of treatment, patients typically get an epidural blood patch: A procedure in which your own blood is injected into your spinal canal, eventually forming a blood clot that seals off the hole or tear and stops the leak, according to the Cleveland Clinic.
Typically, a PDPH is treated using over-the-counter pain relievers, oral or intravenous hydration, and avoiding the upright position. If your MRI reveals a tumor, doctors will determine the best treatment for you depending on its positioning and type.
If the cause of your orthostatic headache is POTS, you can try management techniques for the condition. These techniques might include wearing compression socks, increasing your salt and water intake, raising the top half of your bed (or propping yourself up in bed), and taking certain medications. However, if you’re in need of some quick remedies to soothe your pain until your next doctor’s appointment, try drinking water, getting some rest, using essential oils, or a cold compress. Generally, POTS has a way of knocking you off your game. A few beverages you can also use to soothe your headache include decaf coffee, fruit-infused water, green smoothies, plenty of water, and green, peppermint, and ginger tea.
What are the symptoms of a vascular headache?
A vascular headache is different than an orthostatic headache because the pain is amplified when you’re active They’re also considered migraines, cluster, or toxic headaches. The pain is caused by the blood vessels in your head when they dilate or swell. These headaches usually feel like throbbing on the side of your head. It can also result in loss of appetite, vomiting, diarrhea, lightheadedness, and sensitivity to sounds, light, or smells.
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