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Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
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Persistent orthostatic headache without intracranial hypotension: which treatment?
M Curone1, A Proietti Cecchini, L Chiapparini
1Headache and Neuroalgology Unit, Department of Clinical Neurosciences, Neurological Institute C. Besta, IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy, curone.m@istituto-besta.it.
Summary
Persistent orthostatic headaches without intracranial hypotension are challenging. Antidepressants appear to be the most effective first-line treatment for these difficult-to-diagnose headaches, offering significant pain relief.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Orthostatic headache can indicate intracranial hypotension, but not all cases involve cerebrospinal fluid leaks, posing treatment challenges.
- Persistent orthostatic headaches without clear neuroradiological signs of intracranial hypotension present a diagnostic and therapeutic dilemma for clinicians.
Purpose of the Study:
- To review patients with persistent orthostatic headache and no signs of intracranial hypotension on detailed MRI.
- To evaluate the most effective first-choice treatment for this specific patient group.
Main Methods:
- Systematic review of 11 patients with persistent orthostatic headache evaluated at a headache center.
- Clinical and neuroradiological follow-up over 10 months to 2 years.
- Analysis of various pharmacological treatments administered, including antidepressants, atypical neuroleptics, and muscle relaxants.
Main Results:
- Six patients (54.5%) had previously suspected intracranial hypotension that was not confirmed by MRI.
- Three patients (27.2%) developed headaches after trauma, and two (18%) had a psychiatric history.
- All patients showed improvement with pharmacological treatment; five (45.5%) became pain-free, with antidepressants showing the best outcomes.
Conclusions:
- Persistent orthostatic headache without intracranial hypotension is a complex clinical problem.
- Pharmacological treatment tailored to the patient is recommended.
- Antidepressants are suggested as a potential first-choice treatment for these cases.
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