Headaches When Sitting or Standing: Post-Surgery Symptoms

Headaches occur when sitting or standing, but they do not occur when lying down?

Hello, doctor! I had surgery to remove an intramedullary nail on Saturday, but starting Sunday morning, I experienced pain in the front of my head when I sat up.
However, the pain subsided immediately when I lay down.
After getting up on Sunday, the pain returned, but after sleeping until 1 PM, it disappeared.
On Monday, when I was discharged, I had a headache in the morning and even felt nauseous.
I vomited while riding home, but after sleeping until 3 PM, the symptoms resolved.
This morning, I woke up with a headache again, and I have been sleeping three times during the day.
As of now, at 8 PM, I still have a headache when sitting up, but it goes away when I lie down.
I have taken painkillers, but they have proven ineffective.
I would like to ask the doctor what these symptoms might indicate.

Gary, 20~29 year old female. Ask Date: 2023/01/17

Dr. Peng Shiwei reply Neurology

Hello, your symptoms are most likely indicative of a cerebrospinal fluid leak.
It is recommended that you seek medical attention at a major hospital as soon as possible.
The most effective treatment currently is a blood patch.
However, before you seek medical care, it is advised that you "lie flat as much as possible" and "drink plenty of water." A cerebrospinal fluid leak can potentially lead to severe complications such as cerebral hemorrhage, so please seek medical attention promptly.
Thank you for your inquiry.

Reply Date: 2023/01/17

More Info

It sounds like you are experiencing significant discomfort following your recent surgery, specifically a procedure involving the insertion of an intramedullary nail. The symptoms you describe, particularly the headaches that worsen when sitting or standing but improve when lying down, can be indicative of several potential issues that may arise post-surgery.

Firstly, it’s important to consider the possibility of postural headaches. These headaches can occur due to changes in intracranial pressure when you change positions. After surgery, especially if there was any manipulation of the spine or if you were under anesthesia, your body may react to these changes with headaches. The fact that your headaches improve when lying down suggests that they may be related to changes in blood flow or pressure in your head when you are upright.

Another possibility is that you might be experiencing tension-type headaches, which can be exacerbated by stress, anxiety, or physical strain. The stress of undergoing surgery and the subsequent recovery process can lead to muscle tension, particularly in the neck and shoulders, which can contribute to headaches. The nausea and vomiting you experienced could also be related to the pain and discomfort from the headaches.

Additionally, it is crucial to rule out any complications from the surgery itself. For instance, if there was any bleeding or fluid accumulation in the cranial cavity, this could lead to increased intracranial pressure, which might cause headaches that worsen with certain positions. Another concern could be a post-dural puncture headache, which can occur if there was any accidental puncturing of the dura mater during the procedure, leading to cerebrospinal fluid leakage.

Given that you have already tried over-the-counter pain medications without relief, it would be advisable to follow up with your healthcare provider. They may recommend imaging studies, such as a CT scan or MRI, to rule out any serious complications. Additionally, they might assess your hydration status, as dehydration can also contribute to headaches.

In the meantime, here are some strategies you might consider to help manage your symptoms:
1. Hydration: Ensure you are drinking enough fluids, as dehydration can exacerbate headaches.

2. Rest: Continue to prioritize rest and sleep, as your body is healing from surgery.

3. Positioning: If sitting or standing causes discomfort, try to limit these positions until you can discuss your symptoms with your doctor.

4. Relaxation Techniques: Consider relaxation techniques such as deep breathing, meditation, or gentle stretching to help alleviate tension in your neck and shoulders.

Ultimately, it’s essential to communicate your symptoms clearly to your healthcare provider, especially since they have the context of your surgery and can provide tailored advice. If your headaches persist or worsen, or if you experience any new symptoms, seek medical attention promptly. Your recovery is important, and addressing these headaches will be a crucial part of your healing process.

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