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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
Special laboratory: 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
Related
cerebrospinal fluid (CSF) leakage
General
headache
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 18
American College of Physicians, Philadelphia 2009, 2018