Orthostatic Headache with and without Cerebrospinal Fluid Leak: A Review

Review Article

Submission date: 20th June 2009, Revision date: 8th August 2009, Acceptance date: 17th August 2009


ABSTRACT

Orthostatic headache is a well-known complication of traumatic or iatrogenic dural puncture as well as overdraining ventricular shunts for hydrocephalus. Orthostatic headache that starts spontaneously is most often due to spontaneous cerebrospinal fluid (CSF) leak, but can also occur in the absence of CSF leak. The purpose of this article is to provide a review of the causes, clinical characteristics, pathophysiologic mechanisms, evaluation, and management of orthostatic headache with and without CSF leak. MEDLINE and PubMed searches were used to identify pertinent  articles.

Keywords: headache, orthostatic headache, intracranial hypotension, cerebrospinal fluid leak, postural tachycardia syndrome (POTS)

Correspondence: Bahram Mokri, Mayo Clinic, Neurology, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1-507-284-4036; fax: +1-507-284-4074; e-mail: bmokri@mayo.edu