Positional Headaches, otherwise known as orthostatic or postural headaches, occur when someone has a sudden change in position.
They may occur when you sit-down or stand-up too quickly, and tend to be eased when you lie down for 20-30 minutes. Attacks can last between 5 minutes and 48 hours. The main symptom of Positional Headaches is pain, and they are not commonly associated with other symptoms.
Signs and symptoms of positional headaches
- Pain (severe, throbbing, pulsating, aching, stabbing)
- Worse throughout the day
- Most commonly back of the head, but can be on the side or at the front in rare cases
- Hearing changes or double vision
- Back or chest pain
Activities that may aggravate postural headaches
- Coughing and sneezing
- strenuous exercise
- sexual activity
- bending over, lifting and reaching
- straining during a bowel movement
Spontaneous intracranial hypotension is caused by the leaking of Cerebro-Spinal Fluid (CSF), meaning that there is less fluid cushioning the spinal cord and brain tissue. This causes a disruption in the delicate fluid balance of the central nervous system; even very small leaks can cause a huge change to intra-cranial pressure. This pressure change can be the cause of your headaches.
These events usually occur after spinal surgery that involves puncturing the spinal cord (like a lumbar puncture), or they tend to happen following significant trauma to the head or neck. In some cases, however, it is possible for more subtle events to cause a CSF leak. This might be a sneeze, a cough, or something even less obvious. People who have abnormal connective tissues, or who are hypermobile may be more likely to experience a spontaneous episode of Postural Headache.
In cases of postural headache, where no clear disruption of intra-cranial pressure is detected, there may be another structural cause. In these cases, it is important that your upper cervical spine is properly assessed by your health professional, so that you can get your headache accurately diagnosed.
Management of postural headaches
The management of postural headache is normally a medical procedure called an ‘epidural blood patch’. This involves blood being taken from your arm, and then injected into the epidural space near the leak. This blood is used to form a clot on the dura covering to prevent any further CSF from leaking. This is done under imaging to ensure it is done accurately. This should see an immediate improvement in symptoms. However, some patients may need multiple procedures if the leaking continues.
In mild cases, symptomatic relief can be found when lying flat or during bed rest, with IV therapy or hydration therapy, by avoiding strenuous or upright activities, caffeine consumption or by using an abdominal binder. It is rare for these treatments to be successful as a cure, so it is recommended that you consult with your doctor about the optimal management plan for you.