Orthostatic Headache – Symptoms, Causes, and Management

Orthostatic headache is also known as postural headache as it changes in intensity upon changing position. The headache usually becomes debilitating as soon as the person stands up but goes away slowly within a duration of 20 to 30 minutes upon lying down. The pain is usually felt at the back of head but in the case of a secondary cause, the pain may differ in location. The first suspect of an orthostatic headache is usually a CSF leak that occurs after a spinal tap or lumbar puncture.

Symptoms of orthostatic headache

The symptoms usually depend upon the type of headache but the most commonly observed symptoms in an orthostatic headache are:

  • Severe pain at the back of the head
  • Vision problems
  • Low blood pressure
  • Dizziness
  • Nausea
  • Confusion
  • Blurred vision
  • Phonophobia
  • Tinnitus
  • Lethargy

Pain is usually aching, throbbing, pounding, stabbing, pressure-like, or pulsating depending upon the cause. This is most commonly associated with low-pressure headaches but other headache types may also show these signs.

Causes of orthostatic headache

  • Orthostatic headache is mainly due to low pressure exerted on the brain by cerebrospinal fluid. This can be due to many reasons such as CSF leak, hypotension, spontaneous intracranial hypotension (SIH), and others. As the CSF volume decreases, brain buoyancy decreases, and the brain along with other skull contents shifts downwards, stretching the dura along with it, causing a headache.
  • Low blood pressure can also cause a hypotension headache that aggravates upon standing up and relieves when the person lays down.
  • A sinus or a cerebral lesion might also be the cause as it would get stimulated upon changing position. Other causes are
    • Subdural hematoma
    • Meningitis
    • Trauma
    • Pre-eclampsia
    • Brain stroke
    • Tumors.


  • The first cause your doctor might want to rule out is a CSF Leak, your history of any lumbar puncture or spinal tap might confirm the diagnosis.
  • Other than that MRI Scans, CT Scans, and contrasting images might be suggested.
  • Another test that is performed is a tilt table test in which a person is strap-tied to a table that changes position at regular intervals of 15 minutes. During this time, changes in blood pressure and heart rate are monitored.

Management of orthostatic headache

The treatment only depends upon the cause and severity of symptoms. Usually, lifestyle modifications are required for long term management of symptoms.

Medical Treatment

  • IV fluids: For low blood pressure and Hypovolemia.
  • Antiemetics: Metoclopramide for nausea.
  • Epidural blood patch: To seal the CSF leak.
  • Non-opiate analgesics: For pain relief.

Surgical Treatment

For cysts, tumors, and abnormal growths surgery might be required.

Home remedies

  • Staying hydrated
  • Doing regular exercise
  • Taking frequent meals
  • Increasing salt intake
  • Using compression stockings
  • Taking a well-balanced diet.

When to consult the doctor?

Consult your doctor as soon as warning signs appear such as nausea, vomiting, vision problems, etc. Also, look for any changes in intensity and if your headache doesn’t go away after taking OTC analgesics.


What is the most common cause of orthostatic headache?

It is most commonly caused by CSF Leak and low blood pressure.

What home remedies can I take for the treatment of an orthostatic headache?

Improving diet, and increasing salt and water intake can help.

How long does an orthostatic headache last?

The duration only depends upon the cause. In the case of hypotension, increasing the blood pressure back to normal can bring relief from the headache.

What serious conditions can I be suffering from?

Subdural hematoma, meningitis, brain stroke, or tumor.

Last medically reviewed on August 31, 2022.