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What To Know About Positional Headaches
A positional headache is one that occurs when sitting or standing and improves when lying down. Bending, sneezing, lifting, and straining may also cause it. It often results from a leak of cerebrospinal fluid (CSF) and symptoms usually localize to the back of the head.
Positional headaches are also known as orthostatic, postural, and low pressure headaches.
As well as leaks of CSF, other conditions can cause positional headaches. These include conditions that affect the connective tissues, bones, and nervous system.
This article covers the symptoms and causes of positional headaches, as well as the treatment options available.
Most positional headaches cause pain that is worse when a person is upright and goes away after they lie flat for around 20–30 minutes.
Some people with positional headaches may wake up in the morning with a mild headache that gets worse throughout the day.
It is also not unusual for the positional nature of headaches to go away or become weaker over time.
Positional headaches tend to cause pain in the back of the head, though they can also affect the front of the head, just one side of it, or the entire head. People describe the pain associated with positional headaches as:
Certain actions and activities can make headache symptoms worse. These include:
This section covers some specific causes of positional headaches.
CSF leakThe cause of a positional headache is often low spinal fluid pressure inside the head, which occurs in a condition called intracranial hypotension. Intracranial hypotension generally relates to a loss or imbalance of CSF.
CSF cushions the brain and spinal cord within special membranes called meninges. These meninges prevent the brain and spinal cord from coming into contact with boney structures during movement.
When something damages the meninges, it can allow CSF to leak into the body, lowering fluid volume and pressure.
This change in pressure can drop the position of the brain. This means that the brain is more likely to come into contact with pain-sensitive structures in the head or spine.
Most positional headaches develop while a person is sitting or standing upright. This is because a lot of circulating CSF surrounds the spinal cord, and when someone with reduced CSF levels is standing or sitting, their CSF levels reduce even further. This increases the risk of positional headache.
A doctor will normally rule out a CSF leak before looking into other potential causes.
Cervicogenic headachesPositional headaches can sometimes result from structural problems or conditions that impact parts of the neck, rather than head itself.
For example, the headache could develop due to problems with the:
This is a condition involving dysfunction of the autonomic nervous system, which regulates important processes such as heart function and fluid balance.
Postural orthostatic tachycardia syndrome (POTS) causes rapid heartbeat and blood pressure changes when the person is standing. It may develop after someone with a CSF leak or other debilitating condition has needed to remain bedridden for a long period of time, such as during a prolonged hospitalization.
Anyone at any age can develop POTS, but it mainly affects women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods. POTS often begins after a pregnancy, major surgery, trauma, or a viral illness.
In fact, it has been diagnosed in individuals following infection with COVID-19. People who have long COVID (sometimes called long haulers) may develop POTS. It may make individuals unable to exercise because the activity brings on fainting spells or dizziness.
Learn more about POTS here.
A doctor will typically rule out a CSF leak before testing for other conditions. They will do this by asking questions about the person's symptoms, reviewing their medical history, and ordering diagnostic tests.
Some tests that doctors can use to detect CSF leaks include MRI scans and CT myelography scans.
MRI scans use strong magnetic fields to create an image that reveals typical CSF leak patterns in around 80% of cases. CT myelography scans, meanwhile, use special X-rays and contrasting dye to create detailed images that can reveal damage, abnormalities, or leaks.
To rule out POTS, a doctor may also order a Trendelenburg test. This involves the person lying flat on an exam table that alternates between being horizontal and lowering the head. During this test, a doctor will monitor the person's heart rate and blood pressure.
The best treatment option for positional headaches depends on the underlying cause.
Treatments for CSF leaks vary based on their severity and the location of the leak.
Mild-to-moderate CSF cases may respond to a range of lifestyle remedies, including:
However, some mild-to-moderate CSF symptoms may get better without any treatment.
MedicationCertain medications can also help manage the symptoms of CSF leaks.
However, researchers are yet to prove the effectiveness of most of these. In fact, some of these medications may carry serious health risks, including disability.
Some medications for CSF leak symptoms include:
People with CSF leaks may also need to undergo an epidural blood patch (EBP). This is a procedure wherein a doctor injects 10–100 milliliters of a person's own blood into the epidural space in their spinal canal.
The blood will form a clot which creates a patch on the outer layer of the meninges, which can effectively stop CSF loss.
A doctor will perform an EBP procedure at the location of a leak, or in the middle or lower parts of the spine if they do not know the exact location of the leak.
Health professionals do not know exactly why this procedure seems to help manage CSF leaks. However, at the very least, it seems to help relieve symptoms and confirm the diagnosis.
People should try to avoid strenuous activities or bending over for 4–6 weeks after undergoing an EBP procedure.
Blood patching usually brings instant relief of symptoms, but its effect can wear off, causing the need for multiple procedures.
SurgeryIn severe or chronic cases, or when the precise location of the leak is known, doctors may perform surgery. The type and extent of the surgery depends on individual factors.
Several different types of surgery may be necessary to remove or repair structural abnormalities or abnormal growths, such as tumors, malformations, or cysts.
Managing symptomsThere is no cure for POTS. However, increasing blood volume and helping regulate circulatory conditions can help.
Some medications and lifestyle changes that may assist in this include:
It is difficult to reduce the risk of positional headaches, apart from by practicing good safety, sticking to healthful habits, and addressing any underlying health conditions.
There are several different factors that can increase the risk of developing a CSF leak, which is a common cause of positional headaches. These include:
For the conditions that cause positional headaches, receiving an early diagnosis and prompt treatment usually reduces the risk of serious complications.
See a doctor as soon as possible or seek emergency care if any warning signs of CSF leaks or POTS accompany positional headaches.
Some warning signs of a CSF leak include:
Positional headaches usually occur while a person is standing or sitting upright and improve when they lie down. Only a few conditions can cause them, most notably CSF leaks and POTS.
Some CSF leaks resolve without treatment, whereas others require lifestyle changes, medications, EBP procedures, or surgical repairs.
Treatments for most CSF leaks tend to be successful, but some people may continue to have symptoms and persistent disability after several treatments.
There is no cure for POTS, but people can manage it by making lifestyle changes and taking medication to control blood pressure and volume.
To reduce the risk of complications, speak to a doctor about any unexplained, chronic, or severe headaches, especially those that change with position.
What Are Cluster Headaches?
Cluster headaches cause severe pain around the eye, usually on one side of the head. The pain is stabbing, sharp, or burning rather than throbbing. They start suddenly, occur in groups or clusters, and can last from 15 minutes to several hours.
Cluster headaches occur cyclically. A bout of regular attacks, known as a cluster period, can last a few days, weeks, or months. During remission periods, a person has no headaches.
Cluster headaches are not common, affecting about 1 in 1,000 people. Six out of 10 cases involve men, and most of these are people who smoke. The headaches usually start after the age of 20.
Keep reading to learn more about cluster headaches, including the symptoms, causes, and treatment methods.
Here are some key points about cluster headaches.
Symptoms of cluster headaches include intense pain that starts rapidly and usually without warning. The pain is continuous rather than throbbing. It may cause a stabbing, sharp, or burning sensation.
The pain typically starts around the eye and may radiate to other parts of the head, including the face, neck, and shoulders. Pain may be present in a temple or a cheek. It remains on one side of the head.
There may also be:
The pain can wake a person up during the night, and it may occur at the same time each night.
Each cluster can last from 15 minutes to several hours, but not usually more than 1 hour. After an attack, the pain will be gone, but the person may feel very tired.
TimingA cluster period usually lasts from 6–12 weeks. It often starts at the same time each month, especially during springtime or fall.
Cluster headaches are either:
A cluster period may consist of:
It is not clear exactly why cluster headaches occur.
Research shows that during an attack there is more activity in the hypothalamus, an area of the brain that controls body temperature, hunger, and thirst.
This area of the brain releases chemicals that cause blood vessels to widen, resulting in a greater blood flow to the brain. One theory was that this may cause the headaches. However, this theory has since been rejected.
Other theories relate to inflammatory factors and neurotransmitters. Unfortunately, as this condition is so rare, it is difficult to find larger sample sizes for studies. However, researchers also think there could be a genetic link relating to the cause of the condition.
Some triggers can cause episodes of cluster headaches, such as alcohol, a sudden rise in temperature, or exercising in hot weather. There are also links between cluster headaches and smoking, irregular sleep-wake cycles, and allergies.
There is currently no cure for cluster headaches, but drugs and therapies can reduce the incidence and severity of attacks, such as sumatriptan.
Treatment aims to relieve some of the symptoms, shorten the periods of headaches, and reduce their frequency.
Over-the-counter (OTC) pain medication such as aspirin or ibuprofen can be too slow to effectively reduce pain before the headache is over.
Medications and treatments for cluster headaches aim either to prevent them or to act quickly.
Fast-acting treatmentsA study in 2015 provided clinical guidance on treating cluster headaches, including:
Some new treatment options under investigation include:
People with cluster headaches take short- and long-term medications. When each period of clusters is over, the short-term treatments stop but the long-term ones may continue.
Short-term drugsPeople typically take short-term medications until one of the long-term medications start working.
Examples include:
People may take long-term drugs throughout the cluster period, such as:
Since the causes of cluster headaches remain unclear, there are no proven lifestyle measures for preventing them.
Identifying and avoiding triggers for cluster headaches could reduce their frequency or severity. Possible triggers include:
Cluster headaches and migraine are both severe forms of headache, but they are different and need specific treatments.
Before a migraine headache, a person will typically experience an "aura," or visual disturbances, including flashing lights or zigzag lines. Migraine can last for up to 72 hours, and commonly involves nausea, vomiting, and sensitivity to light.
A cluster headache starts and ends suddenly, and it lasts a shorter time. It can feature congestion, watery eyes, and a runny nose. It normally affects only one side of the head, and the eye that is watering is on the same side.
A person with migraine prefers to lie down during an attack, but people with cluster headaches may find that lying down worsens the pain.
Risk factors for cluster headaches include:
Anyone who has regular headaches should see a doctor. Treatment can relieve symptoms, and it may be necessary to rule out any possible underlying causes.
Vagus nerve stimulation may also be effective.
Learn more about vagus nerve stimulation here.
Cluster headaches are painful headaches that can occur several times a day. Episodes typically come in cycles and may occur around the same time each year.
The symptoms of cluster headaches include sharp, stabbing pain on one side of the head. There can also be restlessness, nasal congestion, and pale skin.
There is currently no cure for cluster headaches. However, people can take a combination of short- and long-term medications to reduce the frequency and severity of episodes.
What Is A Sinus Headache?
A sinus headache is a type of headache that causes pain and pressure in the front of the head and face thanks to inflammation in the sinus passages that are located behind your facial structure.
Fortunately, there are treatment options available that can help ease your discomfort. There might also be things you can do to prevent future sinus headaches.
Most noticeably with a sinus headache, you'll feel moderate to severe pain around the sinus area across the front of your face. The sinuses are the hollow spaces behind your forehead, cheekbones, bridge of the nose, and eyes that help produce mucus.
Sinus headache pain may be constant, throbbing, dull, or gnawing and can become more severe throughout the day. This pain may also get worse when you move your head, bend over, or lie down.
In addition to the telltale pain that comes along with a sinus headache, many people also report experiencing:
These symptoms may be localized to one side or portion of the face, or they may affect both sides of the face equally.
Editor's Note: What many people assume is a sinus headache is actually likely a migraine headache. Sinus headache symptoms like pain, pressure, and congestion can be pretty similar to some migraine symptoms, but there are a couple key differences. Notably, migraine commonly comes with nausea, vomiting, and discomfort to bright lights or loud sounds. If you're experiencing any of those symptoms, check with a healthcare provider for an accurate diagnosis.
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A sinus headache develops when the tissue lining the sinus cavities becomes inflamed. This inflammation is known as rhinosinusitis and most commonly happens with a sinus infection. As the tissue inside the sinuses inflame, mucus increases. The trapped air within the sinuses can cause painful pressure, leading to a sinus headache.
Sinus headaches may also be caused by:
Many sinus headaches are actually incorrectly self-diagnosed—meaning that sometimes, what you think may be a sinus headache may actually be another type of headache or condition, such as migraine
During a medical appointment, the healthcare provider will ask questions about your symptoms and medical history before performing a physical exam. Diagnostic tests can include:
The International Headache Society offers specific criteria to diagnose a sinus headache. According to those guidelines, to be diagnosed as a sinus headache, the headache must be caused by either acute or chronic/recurring rhinosinusitis. You would also need to meet some other key criteria, such as increased pain when pressure is applied to the sinus area.
Before starting any at-home treatments, it's important to figure out if what you're experiencing is actually a sinus headache and not another form of headache or illness.
Treatment options for easing the discomfort of a sinus infection—and in particular, the intense headache that can come along with it—might include:
A sinus headache and its corresponding facial pain or pressure should resolve itself within a week after your sinus infection symptoms have started to dwindle or after you've had a successful course of antibiotics. If you find yourself continuing to experience pain after that period of time, consider checking with a healthcare provider again.
Because most sinus headaches are the result of rhinosinusitis, prevention tips will focus on keeping your sinuses healthy—both on a regular basis, and during an infection or respiratory illness.
For example, experts recommend taking steps like:
Sinus headaches happen when the sinuses (empty spaces behind your facial bones) become inflamed or congested. The most noticeable symptoms include head pain and pressure. These headaches usually develop as a result of rhinosinusitis, inflammation of the nasal cavity and sinuses that may come from a sinus infection, allergies, or another respiratory infection. Sinus headache and migraine can be confused for one another, which is why an accurate diagnosis from a healthcare provider is important. From there, treatment options may include prescription or over-the-counter medications.
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