A positional headache is a type of headache that gets worse when you stand up. The pain tends to subside once you lie down. They’re also known as orthostatic headaches or postural headaches.

In some cases, they’re a sign of a cerebrospinal fluid (CSF) leak. However, several other things can also cause them. Read on to learn more about the other symptoms of a positional headache and how they’re treated.

The main symptom of a positional headache is pain in your head that’s worse when you stand up. In addition, the pain is often more severe in the back of your head and gets worse throughout the day. You should feel relief when you lie down.

If your positional headache is caused by a CSF leak, you might also notice:

  • liquid coming out of your ears or nose
  • vision problems

CSF leak

CSF is found in both your brain and spinal cord. It’s contained within the meninges, which are membranes surrounding them. The CSF in the meninges cushions and protects your brain and spinal cord.

Sometimes, this fluid leaks through a hole in your meninges or skull, usually due to:

CSF leaks can also happen spontaneously without a known cause.

Other causes

Other conditions can also cause positional headaches, including:

  • Postural orthostatic tachycardia syndrome. Often referred to as POTS, this condition involves a rapid heartbeat and changes in blood pressure when you stand up.
  • Colloid cyst. This is a noncancerous brain tumor. If it grows large enough, it can interfere with or block the circulation of CSF.

If you have symptoms of a positional headache, it’s important to see your doctor to rule out any serious conditions that need quick treatment, including a CSF leak.

During your appointment, your doctor will ask about your symptoms. Make sure to tell them what seems to make the pain go away, such as standing up or lying down.

If they suspect you may have a CSF leak or tumor, they may do an MRI scan of your head and spine. This will help them see your meninges and identify any areas of unusual pressure, which could indicate a leak. They might also use a myelogram. This is a type of imaging test that involves a combination of contrast dye in your spine and an X-ray or CT scan.

Your doctor might also perform a tilt table test to rule out POTS. This involves lying down on a table. You’ll be strapped to the table, which will suddenly change positions after about 15 minutes. The table will remain upright for about 45 minutes while your doctor monitors your blood pressure and heart beat.

CSF leak treatment

If you have a CSF leak, the first step of treatment could involve several days of bedrest and drinking plenty of fluids. During this period, you’ll need to avoid heavy lifting and try to limit coughing, sneezing, straining, or other similar actions. Reducing any kind of pressure or straining can help the hole causing the leak to close up on its own. Your doctor might even recommend taking stool softeners to avoid extra straining when going to the bathroom.

If rest doesn’t seem to help, they may recommend an epidural blood patch. This involves injecting some of your own blood into your lower spine. This can plug a CSF leak in your spine. You might need to have this done several times.

In other cases, your doctor might be able to surgically repair the hole, especially if they know its exact location.

Other treatments

If you have a tumor or colloidal cyst, your doctor might remove it with surgery. However, if it’s small, they may decide to just keep an eye on it and prescribe medication to help manage your symptoms in the meantime.

There’s no cure for POTS. However, there are several things you can do to maintain consistent blood pressure and reduce your symptoms, such as:

  • increasing your salt and water intake
  • wearing compression socks
  • raising the top half of your bed
  • taking medications, such as benzodiazepines or beta-blockers

Positional headaches are often a sign of a CSF leakage, though other things can cause them. If you have a CSF leak, there are several treatment options, especially if you catch it early. Regardless of the treatment your doctor recommends, expect to spend a few weeks resting.

While there’s no cure for POTS, home treatments and medication can help you to manage your symptoms. Regardless of the underlying cause, make an appointment with your doctor as soon as possible if you have symptoms of a positional headache.