orthostatic headache

Etiology

• CSF leakage
• many patients report minor trauma
• connective tissue disorder may be risk factor

Epidemiology

• middle-age female

Pathology

• intracranial hypotension

Clinical manifestations

• mimics headache that occurs after traumatic lumbar puncture
• headache present when patient upright, relieved by the supine position
• in some patients, orthostatic features may diminish over weeks to months & the headache may become chronic, daily & continuous
• tinnitus, diplopia, neck pain, nausea, photophobia, phonophobia
• falsely localizing cranial nerve 6 palsy

Diagnostic procedures

see CSF leakage

Radiology

• MRI neuroimaging
  • pachymeningeal enhancement (not nodular)
  • cerebellar tonsil anomalies
  • subdural fluid collections
• CT myelography if unresponsive to epidural blood patch
• also see CSF leakage

Management

• epidural blood patch
• also see CSF leakage

More general terms

• headache

Additional terms

• cerebrospinal fluid (CSF) leakage