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Orthostatic headaches without CSF leak in postural tachycardia syndrome

From the Department of Neurology, Mayo Clinic and Foundation, Rochester, MN.

Address correspondence and reprint requests to Dr. Bahram Mokri, Mayo Clinic, Neurology, 200 First Street SW, Rochester, MN 55905; e-mail: bmokri{at}mayo.edu

Four women age 17 to 28 years presented with orthostatic headaches as the most prominent feature of their symptom complex. None had CSF leak or intracranial hypotension. Autonomic studies showed evidence of orthostatic intolerance with tachycardia in all cases. Treatment of orthostatic intolerance, mainly with volume expansion, was only partially effective. Orthostatic headaches are not always caused by CSF leak or supine intracranial hypotension. Occasionally they may be the major clinical manifestation of postural tachycardia syndrome or orthostatic intolerance.

Received December 6, 2002. Accepted in final form June 17, 2003.

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