Trendelenburg Position: A Tool to Screen for the Presence of a Low CSF Pressure Syndrome in Daily Headache Patients

Authors: Rozen, Todd; Swidan, Sahar; Hamel, Robert; Saper, Joel

Source: Headache: The Journal of Head and Face Pain, Volume 48, Number 9, October 2008 , pp. 1366-1371(6)

Publisher: Wiley-Blackwell

Abstract:

Objective.—

To test the hypothesis that the Trendelenburg position is an accurate screening investigation for the presence of a low cerebrospinal fluid (CSF) pressure syndrome in patients with daily headache. Background.—

The Trendelenburg position causes a rapid increase in intracranial CSF pressure. In a patient with a known CSF leak who overtime had less improvement in the supine position, being placed in Trendelenburg rapidly alleviated her daily headache. This suggested that the Trendelenburg position might be a good screening tool for low CSF pressure syndromes. Methods.—

Case reports. All patients were placed in the Trendelenburg position (10°-20° head-down tilt) for 5 minutes. A patient was considered to have a positive Trendelenburg test if they experienced complete pain freedom or substantial improvement in baseline head pain in the Trendelenburg position. Results.—

Case patients are presented for 3 clinical scenarios: Scenario 1: Daily headache with or without a positional component with a positive response to the Trendelenburg position and subsequent evidence of an underlying low CSF pressure syndrome. Scenario 2: Daily headache with a strong positional component but no improvement in the Trendelenburg position and a negative evaluation for a low CSF pressure syndrome. Scenario 3: Trendelenburg position proves the existence of a post-lumbar puncture headache in patients with near-daily headaches. Conclusion.—

The Trendelenburg position appears potentially useful as a clinical tool to screen for the presence of a low CSF pressure syndrome in patients with daily headache.

Keywords: low CSF pressure syndrome; secondary headache disorder; headache; cerebrospinal fluid

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1526-4610.2007.01027.x

Publication date: 2008-10-01

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