The approach to treating an orthostatic headache depends on the underlying cause. Treatments range dramatically from at-home remedies and lifestyle changes, to medical procedures and even surgery in more serious cases.
Treating a CSF leak
In some cases, a mild CSF leak will resolve on its own. A person experiencing a moderate CSF leak may try the following at-home remedies to treat orthostatic headache symptoms:
- Get extra rest, keeping the body lying in a horizontal lying position
- Stay hydrated by drinking fluids
- Avoid overexertion (e.g. heavy lifting, strenuous exercise)
- Limit coughing and sneezing as much as possible
- Drink coffee, tea, or another caffeinated beverage
- Eat or drink ginger-based substances to help with nausea
- Wear an abdominal binder for compression
- Engage in yoga or meditation
The symptoms of moderate CSF leak headaches may also be treated with:
- Intravenous (IV) fluid therapy: Someone with a CSF leak may lose more fluids than the average person. A hospital can help replenish those fluids through an IV, which gets essential fluids into the bloodstream more quickly and directly.
- IV caffeine therapy: Caffeine can also be delivered intravenously at a hospital as a treatment for headaches, particularly following surgery. This may be effective because caffeine stimulates the body’s central nervous system, which influences and increases blood pressure. It’s also thought that caffeine may ease pain during a headache, by constricting blood vessels that have become painfully enlarged.
- Acupuncture: In some cases, acupuncture has been found to alleviate pain caused by post-dural puncture headaches. A licensed acupuncture practitioner will insert thin needles into the body at specific pressure points, with the goal to stimulate nerves and make them release hormones that may help relieve pain. Acupuncture has mixed results, and its effectiveness is debated by the medical community. Speak with your doctor if you’re interested in trying acupuncture to treat CSF leak headaches.
In the case of a more serious CSF leak, especially if the patient is experiencing chronic or severe positional headaches, a doctor may recommend a procedure called an epidural blood patch (EBP) to give a patient temporary relief of symptoms. Because the procedure must be done at a medical facility and may have uncomfortable side effects such as back pain, this is generally employed only when other forms of treatment have been ineffective.
An EBP procedure involves injecting 10-100 milliliters of the patient’s own blood into the epidural area of the spinal canal. This serves to patch the outer layer of the meninges, reducing the amount of CSF lost through the membrane. A doctor will either perform the EBP at the location of the leak, or—if the exact location of the leak is unknown—near the middle or lower part of the spine. While an EBP procedure immediately resolves pain for most people, the effect of the patch does wear off in time, so lasting relief may require ongoing procedures. It’s recommended to avoid bending over and any muscle strain for 4-6 weeks following an EBP.
In the case of a chronic or severe CSF leak, a doctor may recommend various types of surgery to repair structural issues or remove abnormal growths in the spinal region.
Treating POTS
Although there is no cure for POTS, in the majority of cases, symptoms do improve over time with lifestyle changes and medical treatment.
Treatment plans generally include medications and at-home strategies to mitigate the symptoms. Because this condition affects each patient differently, an individual may need to try a few different methods of treatment before finding the one that’s most effective for their body.
If you have POTS, your doctor may prescribe one or more of the following medications:
- Fludrocortisone: This is a type of corticosteroid that helps your body retain salt and water, both of which are necessary for normal bodily function. POTS often hinders the body from its normal process for balancing bodily fluids, so patients may not retain enough water and salt naturally.
- Midodrine: This is an alpha-adrenergic agonist that works by tightening the blood vessels, thereby increasing blood pressure as a result. Patients with POTS may be advised to take this medication daily, or when they know they’ll be standing upright for a period of time.
- Beta-blockers: By stopping adrenaline from reaching the beta receptors in your body, beta-blockers help to lower both heart rate and blood pressure. Since POTS causes unnecessary spikes in heart rate when standing or sitting up, this medication can be helpful for some patients.
- Selective serotonin reuptake inhibitors (SSRIs): These are antidepressants that help to increase the amount of serotonin that stays circulating in the brain, which can have a relaxing effect on certain body functions, and may help to keep heart rate and blood pressure at reasonable rates.
- Salt tablets: Another method for helping the body to retain essential levels of salt is to take salt tablets.
The primary approach to treating POTS includes lifestyle changes to manage and lessen the symptoms of this condition. Because people with POTS generally have low blood volume, your doctor may recommend adding more salt to your diet and drinking more water to increase your blood volume.
Other lifestyle changes to help manage POTS include:
- Drinking about 16 ounces (or two full glasses) of water before standing up
- Eating smaller meals more frequently to maintain hydration levels
- Sticking to a regular sleep schedule and get enough sleep
- Practicing reclined aerobic activities such as biking and rowing
- Adding salt to your diet (speak with your doctor before doing so)
- Monitoring symptoms to identify—and avoid—your individual triggers