What is Orthostatic Headache?
Orthostaticheadache , also known as positional headache , is a status where a person receive headache when standing up or being in a upright position and the headache subside or gets relieve when the patient role lie down or is in a horizontal stance . Orthostatic cephalalgia used to be wrongly name as differentprimary headachedisorders , such astension headachesor migraine . However , due to the increase awareness of this condition and its cause , it has now become potential to foreclose a misdiagnosis or delayed diagnosis .
Causes of Orthostatic Headache
Decrease in cerebrospinal runny atmospheric pressure is the commonest cause of orthostatic concern . drop-off in cerebrospinal liquid pressure pass from a a post - dural puncture escape , spontaneous cerebrospinal liquid news leak or a traumatic cerebrospinal fluid leak . This is also often the primary symptom of POTS or postural orthostatic tachycardia syndrome , which is a character of dysautonomia . POTS is diagnosed using autonomic examination ; whereas , imagery tests are done to diagnose a CSF making water .
It is difficult to differentiate between POTS and a cerebrospinal fluid escape as the defining symptom of POTS is positional tachycardia , which is also go through by people who have cerebrospinal mobile leaks . to boot both these conditions can also be present in the same patient role , particularly in those citizenry who haveEhlers – Danlos syndrome .
Other cause of Orthostatic Headache include colloid cysts and also connective tissue disorders . Orthostatic headache can also result as a complication of some surgeries , such as decompressive craniectomy for intellectual edema or decompressive surgery for chiari miscreation .
Symptoms of Orthostatic Headache
If the cause of Orthostatic Headache is CSF news leak , then patient role commonly come out to experience the concern within 15 instant of resist up or sitting and it improve 20 - 30 minute after lying down . In some character , there may be many hour before the orthostatic vexation improve or worsen with any modification of position . The location of orthostatic headaches in case of CSF leak is at radix of the skull or ulterior side of the heading . However , it can also occur in the side , front or all throughout the head . Orthostatic cephalalgia is seldom feel on one side of the head . Orthostatic headache is usually described as a pulling character of sensation extending from the headspring to the cervix . The intensity of the orthostatic concern ranges from mild to very austere and can also become quite crippling for the patient .
Some of the other symptoms , which accompany orthostatic head ache , includeneck stiffness , neck pain , nausea , vomiting , sensitiveness to sound / light , lack of coordination , tinnitus , hearing change , visual changes , facial numbness or pain , dizziness orvertigoand change in gustatory modality . The pain of orthostatic headache can also ray to the center of the shoulder blade and into the upper arm . In uncommon cases , pain can also be felt at the site of CSF leak .
Pathophysiology of Orthostatic Headache
As observe previously , the most rough-cut lawsuit of orthostatic cephalalgia is cerebrospinal fluid Leak . CSF leak causes decrease in the book of CSF around the learning ability , which leads to release of buoyancy of the brain resulting in increased pressure on regions , which are pain - sensitive such as dura mater and the pedigree vessels . This grow the pain which is know as Orthostatic Headache . As the brain is dependent on its perkiness , which is present in a vertical or just position , switching to a horizontal position by lying down relieves the orthostatic head ache .
Epidemiology of Orthostatic Headaches
dissimilar types of patients suffer from orthostatic headache . This condition is more dominant in females than male person . Females around the age of 40 usually start to experience orthostatic worry . However , patient of all ages can also suffer from orthostatic worry . CSF leak , which is the common grounds of orthostatic concern , take place more in patient suffering from connective tissue paper diseases , such asEhlers - Danlos syndrome .
Diagnosis of Orthostatic Headache
dissimilar tests are done to diagnose the cause of Orthostatic Headaches including cerebrospinal liquid leaks . A symptomatic dural puncture is generally used , as it easily show the presence of a CSF leak . Other type of tests which are done include cranial CT , spinal MRI , cranial MRI and CT myelography . Diagnosis can be leisurely with a cranial MRI , as it shows the chief findings of CSF leak , which include engorgement of venous structures , sweetening of the meninx , subdural fluent collections , sagging of the brainiac and pituitary hyperaemia .
Treatment of Orthostatic Headache
Orthostatic Headache occurring due to cerebrospinal fluid leaks are treated with bed ease and by give the patient lots of hydration . handling then is done with an epidural blood patch ( EBP ) using autologous blood . If this is not effective , then surgery is done . The eccentric of surgical operation done depend on the size of the leak and on the location of the leak .
If the causa of orthostatic worry is POTS or postural orthostatic tachycardia syndrome , then the treatment is done by do the symptom with dieting , medication and preventive conduct . medicine which are used comprise of fludrocortisone , midodrine , pyridostigmine and droxidopa . These medicine help in stabilizing the blood pressure . Changes in dieting help in ensuring that the patient are getting the necessary amount of smooth intake along with increase in the salinity intake . Dietary changes also help in preventing recurrence of orthostatic vexation .
Abdominal ligature can also be used to alleviate the symptom , as this helps in increasing the pressure of the fluid in the head . Water - bolus intervention helps in event where there is increase orthostatic stress . This treatment comprises of speedy drinking of two 8 ounce glasses of cold water . This help oneself in increasing the standing lineage atmospheric pressure for some amount of time .
Prognosis of Orthostatic Headaches
The prognosis of orthostatic vexation is good . Patients suffering from POTS can manage their orthostatic headaches by identifying when the symptoms are occurring and can strain to prevent orthostatic head ache by making the necessary changes and hence wield their casual life .
Orthostatic cephalalgia occurring from CSF leaks can be managed by repairing the CSF leaks and only a small part of patient have return of orthostatic headaches .
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