Orthostatic headaches are head pain that worsens when standing or sitting upright and improves when lying down. This distinct type of headache can affect any part of the head, though it frequently manifests at the back. While various factors can cause such headaches, there is a recognized association with COVID-19. Understanding this symptom, its connections, and when to seek medical guidance is important.
The COVID-19 Connection
Headaches upon standing have been observed in individuals during the acute phase of COVID-19 infection. Beyond the initial illness, this symptom is more commonly reported as part of Long COVID. Many people who recover from the initial viral infection continue to experience a range of persistent health issues, and orthostatic headaches can be one such manifestation.
Research indicates that a significant percentage of individuals with Long COVID report symptoms consistent with dysautonomia, which can include headaches upon standing. For instance, studies suggest that 66% to 77% of those with Long COVID experience dysautonomia symptoms. These headaches can affect individuals regardless of whether their initial COVID-19 infection was mild or severe. The presence of this symptom after COVID-19 highlights the virus’s potential for broad systemic effects.
Understanding the Mechanisms
The occurrence of headaches upon standing in the context of COVID-19 often relates to disruptions in how the body regulates blood flow and pressure. A primary reason involves the autonomic nervous system (ANS), which controls involuntary bodily functions like heart rate, blood pressure, and digestion. COVID-19 can interfere with the normal functioning of the ANS, leading to a condition called dysautonomia. This malfunction can impair the body’s ability to properly regulate blood flow when changing position, such such as moving from lying down to standing up.
A specific form of dysautonomia frequently linked to post-viral conditions is Postural Orthostatic Tachycardia Syndrome (POTS). Individuals with POTS experience an excessive increase in heart rate upon standing, often accompanied by symptoms like lightheadedness, fatigue, and headaches. While their blood pressure may not drop significantly, altered blood flow regulation means less blood may reach the brain, contributing to the headache. Viral infections are recognized triggers for POTS, and COVID-19 is increasingly identified as one such trigger.
Another mechanism behind orthostatic headaches involves changes in cerebrospinal fluid (CSF) pressure. CSF surrounds the brain and spinal cord, providing cushioning and buoyancy. If there is a loss of CSF volume, the brain can sag when a person is upright, pulling on pain-sensitive structures and causing a headache that resolves when lying down. While not directly caused by COVID-19, it warrants consideration in the evaluation of persistent orthostatic headaches.
Furthermore, dehydration contributes to reduced blood volume. Lower blood volume can make it harder for the body to maintain adequate blood pressure when standing, potentially triggering an orthostatic headache.
When to Consult a Doctor
Seeking medical attention is advisable if you experience headaches upon standing, especially if they are severe or consistently worsen. It is particularly important to consult a healthcare provider if these headaches are accompanied by other concerning symptoms. These can include fainting, vision changes, confusion, weakness, or unexplained chest pain and shortness of breath.
Additional symptoms that warrant medical evaluation alongside orthostatic headaches are persistent nausea or vomiting, neck pain or stiffness, and increased sensitivity to light or sound. Problems with balance, a feeling of “brain fog,” or numbness and tingling sensations in the limbs also signal a need for professional assessment. If these symptoms significantly interfere with your daily activities or do not improve with basic home care, a doctor can help determine the underlying cause and recommend appropriate management. Informing your doctor about any recent COVID-19 infection is also helpful, as it provides important context for diagnosis.
Relief at Home
Several practical strategies can help manage headaches that occur upon standing. Maintaining adequate hydration is a fundamental step, as dehydration can reduce blood volume and contribute to these headaches. Aiming for consistent fluid intake throughout the day, possibly 2 to 3 liters or more, can support overall blood volume.
Increasing salt intake, under medical guidance, may also be beneficial for some individuals, particularly those with dysautonomia, as it helps expand blood volume. This might involve adding more salt to food or using electrolyte solutions, with typical recommendations ranging from 5 to 9 grams of salt daily. However, it is important to discuss this with a healthcare professional, especially if you have conditions like high blood pressure.
Moving slowly when transitioning from a lying or sitting position to standing allows your body more time to adjust to the change in posture, which can lessen the sudden drop in blood pressure that might trigger a headache. Wearing compression stockings, particularly those that extend to the waist, can help prevent blood from pooling in the lower extremities. This external pressure supports venous return to the heart, which can improve blood flow regulation when upright.
Eating smaller, more frequent meals can also be helpful, as large meals can sometimes divert a significant amount of blood flow to the digestive system, potentially leading to a temporary drop in blood pressure. Recognizing and avoiding triggers such as prolonged standing or hot environments can contribute to symptom management. Always consult with a healthcare provider before making significant changes to your diet or lifestyle, especially if you have existing health conditions.