Why Do I Feel A Headache When Standing Up?

If you have undergone a spinal tap or received spinal anesthesia and face debilitating headaches that worsen when you stand up, do not waste time seeking medical help. You can rely on the expertise and knowledge of doctors at Advanced Headache Center to know what is causing the intense pain that affects even regular movements and activities like sitting and standing up. The specialist doctor will figure out the causes behind your spinal headaches and work out the symptoms to ensure long-term health and wellbeing.

What Are Spinal Headaches?

Spinal headache occurs in people who have undergone a spinal tap or have received spinal anesthesia during surgical procedures. These procedures are carried out to diagnose illnesses or deliver anesthesia, especially for giving epidural during childbirth.

During these procedures, a thin needle is used to puncture the membrane surrounding the spinal cord and the nerve roots of the lower spine. If any spinal or cerebrospinal fluid leaks out of the tiny hole created by the needle, it reduces the fluid balance surrounding and cushioning the brain, causing a spinal headache. The nerves and tissues surrounding the brain become stretched, which produces a sensation of pain.

Also known as post-dural puncture headaches and epidural headaches, these headaches are often described as ‘the worst headaches ever’ by sufferers or ‘a headache like no other due to the intense pain they cause.

Spinal Headache

Difference Between Spinal Headache and Regular Headache

Regular headaches originate in the cranial area and are not in any way connected with the spine. The root cause of this headache makes it different from other headaches, including migraine and tension-type headaches.

Its postural symptoms characterize this headache. The headaches get worse when you are sitting or standing up but improve immediately when you lie down. People with spinal headaches experience intense symptoms within 15 to 30 minutes of sitting or standing up. This is due to the brain settling on the skull base due to loss of cerebrospinal fluid and a drop in the fluid pressure.

Spinal Headache Causes

A spinal headache can result after certain procedures, including:

  • A lumbar puncture
  • A spinal tap
  • An epidural block

40% of the patients receiving these procedures reported a spinal headache immediately afterward.

Other conditions that can cause spinal headache include:

  • Ruptured (burst) cyst on the spinal cord
  • Ahead or face injury such as a fractured skull
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Spinal Headaches Symptoms – What Actually Happens?

A spinal headache develops within a few minutes after the spinal tap or lumbar puncture. Usually, it occurs within a day or two and interferes with normal function and daily activities.

The symptoms of spinal headache can include:

  • Headache when standing up
  • A dull and throbbing pain that can range from mildly uncomfortable to debilitating
  • Pain that increases when you are sitting down or standing up
  • Pain that increases when you cough, sneeze, or strain

Additional symptoms may include:

  • Ringing in the ears
  • Nausea
  • Dizzy spells
  • Sensitivity to light
  • Stiffness in the neck
  • Blurred or double vision

The pain caused by a spinal headache can last up to 5 days and sometimes even more, depending on how soon the pressure is restored in the spinal cord.

How Are Spinal Headaches Diagnosed?

The doctor will diagnose a spinal headache based on your medical history and symptoms. If you have had a spinal tap or lumbar puncture within the past few days, diagnosis is clear, and no tests are needed.

If you suffer from spinal headaches without going through a spinal tap, it requires complete investigation. The doctor will take your medical history, do a physical exam and recommend an MRI – magnetic resonance imaging to diagnose your condition. These tests will enable the doctor to look for signs of leaking spinal fluids and understand the reasons behind these headaches.

Spinal Headaches Treatment

Spinal headaches are painful and even disruptive when they occur, but they are not a serious health concern. Spinal headache treatment is targeted to replenishing the brain fluid and restore proper pressure to the spine. The top headache specialist will investigate the reasons behind your condition and come up with curative approaches to alleviate the pain and provide lasting relief. Treatment options are both conservative and minimally invasive to reduce the head pain as soon as possible.

To manage spinal headaches, your doctor may suggest:

  • Bed rest to reduce pain as the headache becomes worse when you are standing up
  • Proper hydration that promotes cerebral spinal fluid pressure
  • Intake of caffeinated beverages such as coffee, tea, and soft drinks
  • Over the counter pain relievers such as ibuprofen or acetaminophen

In case the abovementioned treatment options do not offer the desired relief, the pain management doctor might suggest:

  • Intravenously delivered caffeine
  • Epidural blood patch
  • Surgery to seal or patch the hole as a last resort to relieve the headache

A blood clot from your own blood will be injected into space over the puncture hole along the spine during this procedure. When the blood clots, it seals the hole and prevents further cerebrospinal fluid leak (CSF). It is a safe and effective, minimally invasive procedure that increases spinal fluid pressure and alleviates pain.

Spinal headaches can get better with home treatments without requiring medication or an epidural blood patch. If your symptoms persist and the headaches seem to worsen significantly when you stand or sit, consult an expert doctor to ensure there is no underlying medical condition or a life-threatening cause behind the pain. Professional advice is essential to know more about the type of headache you suffer from and determine the best course of action.

Suffering from spinal headaches is not a pleasant feeling if you are already recovering from the effects of a spinal tap procedure. The specialist doctors at the Advanced Headache Center come up with the most targeted treatment options to alleviate the discomfort and help you get back to your routine activities. The pain management doctor will develop the least invasive and effective ways to care for your spinal headache pain and ensure you live a better quality of life.

Updated on Jan 31, 2024 by Dr. Amr Hosny (Headache Specialist) of Advanced Headache Center

Amr Hosny, MD, MBA, AQH

Dr. Hosny is an Ivy League Trained, UCNS-accredited, board-certified headache specialist who offers the latest preventive and abortive treatments to provide safe and effective head pain relief. As an active member of prominent organizations and professional societies that advance headache science, education, and management, such as the National Headache Foundation, Dr. Hosney specializes in diagnosing and treating a wide range of head pain disorders, including tension headaches, migraines, and cluster headaches, to name a few.

Dr. Hosny's reputation for enhancing headache care quality through the use of the most effective and technologically advanced treatment options for persistent primary and secondary chronic headaches has been acknowledged by Castle Connolly and Healthgrades, where he has received over 200 positive reviews. Dr. Hosny is also recognized as a distinguished New York City physician and headache specialist by New York Magazine.

More about Dr. Hosny
Advanced Headache Center 41 5th Avenue,
New York, NY 10003
(646) 763-2222