Why Standing Up May Cause Head Pain

Dehydration, spinal fluid leaks and other conditions can cause positional headaches when you stand up

Does your head often hurt when you stand up or get out of bed? That’s called getting a positional headache. And it’s worth paying attention to — and discussing with your provider.

“Head pain that comes on when you change positions is usually a symptom of an underlying condition,” says family medicine specialist Scott Owen, DO. “It’s often something simple, like dehydration. But it may be something more serious.”

Dr. Owen explains what causes head pain when standing up and when to seek medical care.

Why does my head hurt when I stand up?

Positional headache is head pain that occurs when you stand up from a seated or prone (lying down) position. You may also hear it called a “postural headache” or an “orthostatic headache.” Orthostatic means straight or upright.

“Postural headaches are secondary headaches, meaning the head pain is a symptom of another condition,” explains Dr. Owen. Secondary headaches differ from primary headaches, such as tension headaches and migraines. Primary headaches are conditions all by themselves — not symptoms of a different health concern.

What does a positional headache feel like?

Head pain when standing from a seated or prone position is the main symptom of a positional headache. The aching or throbbing pain often gets better and may even go away when you lie down. Sometimes, the head pain gradually worsens as you go about your day.

The location of the head pain can vary depending on the underlying cause. “Most positional headaches affect both sides of the head,” says Dr. Owen.

What causes head pain when standing up?

Many conditions — some serious, some not so serious — can cause a positional headache.

Dehydration

If your head pain occurs throughout the day but is gone the next day, it may be a sign that you need to drink more fluids. “Dehydration can provoke most types of headaches,” says Dr. Owen.

In addition to getting a headache when you stand, a headache from dehydration can also cause:

• Dark urine
• Dizziness
• Dry mouth
• Fatigue
• Muscle spasms or cramps

The solution for this type of positional headache is simple: Drink more water or electrolyte beverages.

Cerebrospinal fluid leak

A positional headache that lasts for a long time or keeps coming back (chronic) may be a sign that cerebrospinal fluid (CSF) is leaking through an opening in brain tissue called the dura. CSF cushions your brain and spinal cord, protecting them from injuries and sudden movements.

“When you have a cerebrospinal leak, fluid pressure inside your head drops,” explains Dr. Owen. This pressure change is known as intracranial hypotension. Intracranial means “inside your skull.” Hypotension refers to pressure that’s lower than normal.

A CSF leak is more likely to occur after a procedure, like a lumbar puncture (spinal tap) or epidural. Brain and spinal injuries can also cause a CSF leak.

“If you experience a postural headache within hours of a procedure or injury, you need medical attention,” stresses Dr. Owen.

Depending on the severity of the leak, you may need an epidural blood patch. A provider injects some of your blood into your spinal canal to help clot the blood and stop the leak. It may sound scary, but the relief it offers is usually instantaneous.

While it’s less common, a CSF leak can also be spontaneous or idiopathic, meaning it wasn’t caused by a procedure or injury. The leak just happened, and there’s no clear reason why.

People with certain connective tissue diseases, such as Marfan syndrome and Ehlers-Danlos syndrome, are most at risk of CFS. Idiopathic intracranial hypertension(unexplained high pressure inside the skull) can also cause or indicate a spontaneous CSF leak. Altitude sickness medications often ease head pain caused by spontaneous CSF leaks.

Other causes

Several other health conditions can cause a positional headache. In these cases, treating the underlying condition often improves the head pain.

• Arthritis and injuriesthat affect the cervical spine or neck can cause cervicogenic headaches. Head pain may worsen when you stand up or move your head.
• Chiari malformation occurs when brain tissue pushes into the spinal canal at the base of your skull, putting pressure on your spinal cord. Moving your head or changing your head position can increase this pressure, causing a positional headache.
• Orthostatic hypotension (a sharp drop in blood pressure when standing up) typically causes dizziness immediately after waking up. But you can also get headaches, especially if you take blood pressure medications.
• Postural orthostatic tachycardia syndrome (POTS) tends to make you dizzy when you stand and may cause positional headaches.
• Severe anemia (low red blood cells) or blood losscan reduce how much oxygen reaches your brain, causing head pain.
• Brain tumors can make your head hurt when you bend over or change positions, though they’re rarely a cause of positional headaches. You’re also more likely to have symptoms like nausea, vomiting or seizures.

When to seek medical care for a positional headache

Contact a healthcare provider if you experience any type of headache along with nausea, vomiting or other worrying symptoms like seizures. It’s also important to seek care if you develop positional headaches after a medical procedure or injury.

“A positional headache can indicate changes in fluid pressure in the brain that require medical attention,” reiterates Dr. Owen. To figure out the cause, your provider may perform a physical exam, review your medical history and evaluate your symptoms. A brain MRI can show changes in CSF fluid and identify conditions like Chiari malformations that can cause postural headaches.

“Most headaches aren’t a sign of something serious, and the likelihood of a brain tumor causing a postural headache is very low,” he adds. “Still, tell your provider about any unusual or chronic head pain.”