Headaches that emerge or intensify upon standing, known as orthostatic headaches, can be a concerning symptom. This article explores their nature, underlying physiological mechanisms, and connection to COVID-19, including associated symptoms and management approaches.
Orthostatic Headaches Explained
Orthostatic headaches are characterized by head pain that is triggered or worsened when a person assumes an upright position, whether sitting or standing. They typically improve or resolve when lying down. This positional change in pain is a defining feature. The underlying physiological reason for these headaches involves changes in either cerebrospinal fluid (CSF) pressure or the brain’s blood flow.
When CSF pressure is low, the brain loses buoyancy, causing it to sag and exert pressure on pain-sensitive structures within the skull. This mechanical traction results in the headache. Additionally, orthostatic headaches can arise from inadequate blood supply to the brain when upright. Common non-COVID causes include spontaneous CSF leaks, leaks following procedures like lumbar punctures, dehydration, or other conditions leading to low blood pressure.
COVID-19 and Orthostatic Headaches
There is an established link between COVID-19, both during acute infection and as part of long COVID, and the development of orthostatic headaches. A primary mechanism for this connection is dysautonomia, a condition where the autonomic nervous system (ANS) malfunctions. The ANS regulates many involuntary bodily functions, including heart rate and blood pressure, which are crucial for maintaining stable blood flow to the brain when changing positions.
COVID-19 can disrupt this system, leading to impaired blood pressure regulation and reduced blood flow to the brain when upright. Postural Orthostatic Tachycardia Syndrome (POTS) is a common form of dysautonomia observed after COVID-19 infection. Individuals with POTS experience an increase in heart rate upon standing, often without a significant drop in blood pressure. This happens because blood tends to pool in the lower limbs, reducing the amount of blood returning to the heart and to the brain. The infection may trigger the production of autoantibodies that affect autonomic nerve fibers and receptors, contributing to this dysfunction. The prevalence of POTS has increased following the COVID-19 pandemic.
Recognizing Accompanying Symptoms
Orthostatic headaches, especially with COVID-19 or post-COVID conditions, often appear alongside other symptoms. Individuals may experience dizziness, lightheadedness, or faintness when upright. Cognitive difficulties, often described as “brain fog,” and persistent fatigue are also commonly reported.
Other accompanying symptoms can include heart palpitations, shortness of breath upon standing, nausea, and chest pain. It is important to seek medical attention if a headache is severe or sudden in onset, or if it is accompanied by new neurological deficits such as weakness, vision changes, or confusion. Persistent worsening of symptoms, changes in headache patterns, fever, neck stiffness, or clear fluid or blood leaking from the ears or nose are also signs that warrant immediate medical evaluation.
Steps for Relief and Medical Guidance
Managing orthostatic headaches often involves a combination of lifestyle adjustments aimed at improving blood volume and circulation. Adequate hydration is a foundational step, with a general recommendation to consume approximately 2 to 2.5 liters of fluids daily. Increasing salt intake, ranging from 3,000 to 10,000 milligrams per day, can also be beneficial as it helps retain water in the bloodstream, though this should always be discussed with a healthcare professional.
Making slow and gradual changes in body position when moving from lying to sitting or standing can help the body adjust to gravitational changes. Wearing compression garments, such as waist-high stockings or abdominal binders, can support circulation by reducing blood pooling in the lower extremities. Elevating the head of the bed during sleep and consuming smaller, more frequent meals can help alleviate symptoms. Avoiding prolonged standing and hot environments, which can exacerbate symptoms, is also advisable. It is important to consult a healthcare professional for an accurate diagnosis and a personalized management plan, as specific medications may also be considered to address underlying conditions.