Table of ContentsView AllTable of ContentsWhat It IsSymptomsCausesRisk FactorsDiagnosisOther Possible CausesTreatmentComplicationsWhen to Seek Medical Care
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Causes
Risk Factors
Diagnosis
Other Possible Causes
Treatment
Complications
When to Seek Medical Care
If you experience a headache when standing, it may be due to low cerebrospinal fluid (CSF). A CSF headache is one type of positional headache that arises due to insufficient spinal fluid pressure on the brain.Other causes of positional headaches could relate to the neck or the autonomic nervous system, among other conditions.
The primary characteristic of a low CSF pressure headache is pain that starts or worsens when you sit up or stand and goes away when you lie down.Low spinal fluid is not always dangerous, and a mild to moderate case of low CSF can resolve on its own or with at-home treatment.
This article provides a brief overview of low CSF pressure headaches, including causes and symptoms. It also discusses diagnosis and treatment.
Terry Vine / Getty Images
What Is a Low CSF Pressure Headache?
The pain and other symptoms arise as the brain moves excessively and distresses surrounding nerves. This condition is sometimes also called a “positional headache” because it arises—and goes away—due tochanges in the position of your head.With this type, the pain and other symptoms begin when you are upright and go away when you lie down.
What Is Cerebrospinal Fluid?
Symptoms of a Low CSF Pressure Headache
The primary symptom of positional headache due to low CSF pressure is head pain that gets worse when you stand up or move and eases off when you lie down. For some, it comes on quickly. For others, it has a more gradual onset.
Typically, the symptoms start within 15 minutes of being upright and go away 15–30 minutes after lying down.In some cases, however, the time between onset and improvement can take one or more hours.
Pain with positional headache due to low CSF pressure ranges from dull and manageable to severe and debilitating. These headaches are typically:
In addition, these headaches may cause:
Causes of a Low CSF Pressure Headache
The CSF loss lowers the pressure it places on the brain, calledintracranial hypotension, leaving this vital organ with less support. When standing or when upright, it sinks to a lower-than-natural position, which stretches the surrounding meninges and nerves, causing pain.
CSF leaks can also occur without any identifiable cause.
CSF leaks are more common in people who are:
Diagnosing Low CSF Pressure Headaches
Diagnosis of this condition can be difficult, especially when the symptoms are mild to moderate. Several procedures and tests may be involved, including:
Other Causes of Headaches When Standing Up
Treatment for positional headaches due to low CSF pressure can be challenging since most standard headache therapies don’t work. Therapy is successful when the tear or malformation in the spinal meninges is closed, stopping the CSF leak. There are several interventions that healthcare providers try.
Rest and Recovery
As noted, lying down for some time should relieve the headache. The first line of treatment for milder cases involves bed rest, increasing fluids to stay hydrated, and taking caffeine (either as coffee or tea or in pill form).Given time, many cases resolve without additional treatment.
Epidural Blood Patch
If the headache doesn’t resolve on its own, anepidural blood patchprocedure is the standard treatment.The specialist, usually an anesthesiologist, takes blood from a vein and injects it near the hole in the meninges or at a safe distance if the exact location is unknown.
This blood forms a clot at the rupture, providing nearly instantaneous relief of symptoms. This therapy may need to be repeated.
Surgical Repair
If the exact location of the tear in the meninges is known, repair of the site can be considered. UsingX-ray imagingas a guide, an interventional radiologist can use a specialized needle to deliver adhesive to the tear. If there’s a larger tear in the spine, a neurosurgeon may attempt surgery to repair it.
Rebound Intracranial Hypertension HeadacheIn rare cases, pressure on the brain and spine becomes elevated following treatment for low CSF pressure headaches, resulting inrebound intracranial hypertension headaches. Symptoms including:Frequent, severe headacheNausea and vomitingBlind spots in the field of visionPain behind the eyeTinnitusNeck stiffnessPain in the arms and legsMemory problemsTreatment for this condition involves lifestyle modifications or taking medications such as Diamox (acetazolamide) and Topamax (topiramate).
Rebound Intracranial Hypertension Headache
In rare cases, pressure on the brain and spine becomes elevated following treatment for low CSF pressure headaches, resulting inrebound intracranial hypertension headaches. Symptoms including:Frequent, severe headacheNausea and vomitingBlind spots in the field of visionPain behind the eyeTinnitusNeck stiffnessPain in the arms and legsMemory problemsTreatment for this condition involves lifestyle modifications or taking medications such as Diamox (acetazolamide) and Topamax (topiramate).
In rare cases, pressure on the brain and spine becomes elevated following treatment for low CSF pressure headaches, resulting inrebound intracranial hypertension headaches. Symptoms including:
Treatment for this condition involves lifestyle modifications or taking medications such as Diamox (acetazolamide) and Topamax (topiramate).
Positional headaches due to low CSF pressure can occasionally lead to serious complications. This can cause symptoms that resemble other conditions, including:
Complicated cases can lead to loss of consciousness,coma(a state of prolonged unconsciousness),strokes(blood supply to the brain is interrupted or reduced), and even death.
Medical care is called for if you experience low CSF pressure headache symptoms, and certainly if you experience the other symptoms of a CSF leak. Get help if you experience:
Summary
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Low CSF headache.American Migraine Foundation.What to know about low-pressure headaches.National Organization for Rare Diseases.Spontaneous intracranial hypotension.American Migraine Foundation.What is cervicogenic headache? How do you treat it?.Arca KN, Halker Singh RB.Dehydration and Headache.Curr Pain Headache Rep. 2021;25(8):56. Published 2021 Jul 15. doi:10.1007/s11916-021-00966-zNational Organization for Rare Disorders.Idiopathic intracranial hypertension.Harvard Health Publishing.Headache pain: When to worry, what to do.Additional ReadingDeline C, Schievink W.Spontaneous intracranial hypotension. National Organization for Rare Diseases. Updated 2020.Friedman D.What to know about low-pressure headaches. American Migraine Foundation. Published January 12, 2017.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Johns Hopkins Medicine.Low CSF headache.American Migraine Foundation.What to know about low-pressure headaches.National Organization for Rare Diseases.Spontaneous intracranial hypotension.American Migraine Foundation.What is cervicogenic headache? How do you treat it?.Arca KN, Halker Singh RB.Dehydration and Headache.Curr Pain Headache Rep. 2021;25(8):56. Published 2021 Jul 15. doi:10.1007/s11916-021-00966-zNational Organization for Rare Disorders.Idiopathic intracranial hypertension.Harvard Health Publishing.Headache pain: When to worry, what to do.Additional ReadingDeline C, Schievink W.Spontaneous intracranial hypotension. National Organization for Rare Diseases. Updated 2020.Friedman D.What to know about low-pressure headaches. American Migraine Foundation. Published January 12, 2017.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Johns Hopkins Medicine.Low CSF headache.American Migraine Foundation.What to know about low-pressure headaches.National Organization for Rare Diseases.Spontaneous intracranial hypotension.American Migraine Foundation.What is cervicogenic headache? How do you treat it?.Arca KN, Halker Singh RB.Dehydration and Headache.Curr Pain Headache Rep. 2021;25(8):56. Published 2021 Jul 15. doi:10.1007/s11916-021-00966-zNational Organization for Rare Disorders.Idiopathic intracranial hypertension.Harvard Health Publishing.Headache pain: When to worry, what to do.
Johns Hopkins Medicine.Low CSF headache.
American Migraine Foundation.What to know about low-pressure headaches.
National Organization for Rare Diseases.Spontaneous intracranial hypotension.
American Migraine Foundation.What is cervicogenic headache? How do you treat it?.
Arca KN, Halker Singh RB.Dehydration and Headache.Curr Pain Headache Rep. 2021;25(8):56. Published 2021 Jul 15. doi:10.1007/s11916-021-00966-z
National Organization for Rare Disorders.Idiopathic intracranial hypertension.
Harvard Health Publishing.Headache pain: When to worry, what to do.
Deline C, Schievink W.Spontaneous intracranial hypotension. National Organization for Rare Diseases. Updated 2020.Friedman D.What to know about low-pressure headaches. American Migraine Foundation. Published January 12, 2017.
Deline C, Schievink W.Spontaneous intracranial hypotension. National Organization for Rare Diseases. Updated 2020.
Friedman D.What to know about low-pressure headaches. American Migraine Foundation. Published January 12, 2017.
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