Headaches are never pleasant, and when severe enough, they can leave us lying in bed wishing for relief. There are many types of headaches, differing based on their location or cause. An orthostatic headache is one type, and it occurs (or worsens) when standing up.
There are many causes of orthostatic headaches, some of which include dehydration, low blood pressure, POTS, and CSF leaks. If you are suffering from chronic orthostatic headaches, it is always recommended to visit a doctor to determine what is causing them.
What Is an Orthostatic Headache?
An orthostatic headache is also known as a positional or postural headache, and it is a headache that occurs when you stand up. Generally, those with an orthostatic headache find that their pain dissipates when they lie down.
Orthostatic Headache Symptoms
An orthostatic headache’s primary symptom is head pain that worsens when standing up and gets better when lying down. Additionally, pain from an orthostatic is often more severe in the back of the head and gets worse throughout the day.
Those with an orthostatic headache due to a leak in their cerebrospinal fluid (CSF) may also have symptoms of vision problems and clear liquid or blood coming out of the nose or ears.
What Causes Orthostatic Headaches?
These headaches could be a sign of problems in multiple areas.
Orthostatic headaches often occur due to poor blood pressure regulation, specifically a drop in blood pressure. When you are dehydrated, the fluid volume in your body is low, which can cause your blood pressure to drop when standing up.
Cerebrospinal fluid (CSF) is contained within the meninges, which are membranes that surround the brain and spinal cord. The CSF plays a vital role in cushioning the brain and spinal cord.
In some cases, this fluid can leak through a hole in the meninges or skill, typically because of a:
- head injury
- spinal tap
However, CSF leaks can also happen spontaneously and without a known cause.
Postural Orthostatic Tachycardia Syndrome (POTS)
This condition is characterized by a rapid heartbeat and changes in blood pressure when standing up. This drop in blood pressure may lead to a positional headache.
Structural Neck Issues
A cervicogenic headache is a specific type of positional headache that can result from conditions impacting intervertebral discs, skeletal muscles, nerves, joints, connective tissue, or blood vessels in the neck.
With a cervicogenic headache, the pain is often only on one side of the head and starts in the neck. Additionally, the pain is set off with neck movement.
Depending on the location of the brain tumor, it may block CSF flow in the brain, which can cause a significant change in CSF pressure upon standing. This change in pressure can then result in a headache.
In addition to blood pressure, your blood volume can also contribute to head pain. If you suffer from severe anemia, you likely have low blood volume, inhibiting blood flow to the brain and making headaches worse when standing up because it becomes harder to pump blood to the brain.
How Is an Orthostatic Headache Diagnosed?
When you have an orthostatic headache, your doctor will often first want to rule out POTS or a CSF leak, which are the two most common causes of these headaches.
To test for POTS, your doctor will likely have you complete a tilt table test or a standing test, which aim to see if POTS symptoms are triggered by body position.
The most common diagnostic test for a CSF leak is an MRI brain scan. Your doctor may also perform a CT cisternogram if they have difficulty determining the leak’s exact location.
If your doctor has ruled out both POTS and a CSF leak, they will then assess for less common causes of positional headaches such as anemia, neck issues, or brain tumor.
How To Treat An Orthostatic Headache
The treatment for an orthostatic headache depends on its underlying cause, and it can include medications, at-home remedies, or surgery.
If your orthostatic headache is due to POTS, there is no way to cure this condition, but lifestyle changes and medical treatment can improve symptoms. In general, treatment includes medications and at-home strategies to alleviate symptoms.
In mild cases of orthostatic headaches due to a CSF leak, the leak is left alone to heal on its own. The following at-home solutions can help to treat orthostatic headache symptoms as the leak heals:
- stay hydrated
- get extra rest
- limit coughing and sneezing
- avoid overexertion
- eat or drink ginger-based substances
- drink tea, coffee, or other caffeinated beverages
- try meditation or yoga
Moderate CSF leaks may also be treated with intravenous fluid therapy, acupuncture, or IV caffeine therapy.
If the CSF leak is severe, an epidural blood patch (EBP) may be recommended to help temporarily relieve symptoms. This procedure is typically only considered if other forms of treatment have been ineffective, though, because it must be performed at a medical facility and can cause back pain. Chronic or severe CSF leaks may also be treated with surgery to remove abnormal growths in the spinal region or repair structural issues.
When To See a Doctor
If you are experiencing chronic or intense headaches with no explanation, it is recommended to visit a doctor to rule out serious causes.
Additionally, the following symptoms may be warning signs of POTS or a CSF leak, so if they accompany your headache, be sure to seek immediate medical attention:
- neck pain
- nausea and vomiting
- vertigo, dizziness, or brain fog
- pain between the shoulder blades
- nipple discharge
- pain or numbness in the arms
- sudden changes in blood pressure or heartbeat upon standing
Get Help from An Online Doctor
If you believe that you have a positional headache and want to discuss its potential causes, an online doctor can help. With DrHouse, you can meet with a doctor in just 15 minutes from the comfort of your home to explore potential causes and treatments.
Orthostatic headaches, also known as positional headaches, occur when standing up. There are many causes of these headaches, including dehydration, POTS, CSF leaks, brain tumors, anemia, and structural neck issues.
When diagnosing the cause of positional headaches, your doctor will typically start by performing tests to rule out POTS or CSF leaks, which are some of the most common causes of orthostatic headaches. Treatment then depends on the condition causing the headache, although at-home remedies such as staying hydrated, avoiding overexertion, and getting plenty of sleep are essential no matter the cause.
If you suffer from orthostatic headaches, especially chronic or intense ones, it is recommended to see a doctor to determine the cause and find treatment to relieve your pain.
- Al Khalili Y, Ly N, Murphy PB. Cervicogenic Headache. [Updated 2022 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507862/
- Foundation, S. (2022). Diagnosis of Spinal CSF leak – Diagnosis – Spinal CSF Leak Foundation. Retrieved 29 July 2022, from https://spinalcsfleak.org/about-spinal-csf-leaks/diagnosis-of-spinal-csf-leak/
- Fedorowski, A. (2018). Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. Journal Of Internal Medicine, 285(4), 352-366. doi: https://www.doi.org/10.1111/joim.12852
- Johnson, J., Mack, K., Kuntz, N., Brands, C., Porter, C., & Fischer, P. (2010). Postural Orthostatic Tachycardia Syndrome: A Clinical Review. Pediatric Neurology, 42(2), 77-85. doi: https://www.doi.org/10.1016/j.pediatrneurol.2009.07.002
- Mokri, B. (2014). Spontaneous CSF Leaks. Neurologic Clinics, 32(2), 397-422. doi: https://www.doi.org/10.1016/j.ncl.2013.11.002
- Dobrocky, T., Nicholson, P., Häni, L., Mordasini, P., Krings, T., & Brinjikji, W. et al. (2022). Spontaneous intracranial hypotension: searching for the CSF leak. The Lancet Neurology, 21(4), 369-380. doi: https://www.doi.org/10.1016/s1474-4422(21)00423-3