@article {Rozen:October 2008:0017-8748:1366,
	author = "Rozen, Todd",
	author = "Swidan, Sahar",
	author = "Hamel, Robert",
	author = "Saper, Joel",
	title = "Trendelenburg Position: A Tool to Screen for the Presence of a Low CSF Pressure Syndrome in Daily Headache Patients",
	journal = "Headache: The Journal of Head and Face Pain",
	volume = "48",
	year = "October 2008",
	abstract = "Objective.&#8212; <P></P>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.&#8212; <P></P>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.&#8212; <P></P>Case reports. All patients were placed in the Trendelenburg position (10&#176;-20&#176; 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.&#8212; <P></P>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.&#8212; <P></P>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.",
	pages = "1366-1371(6)",
	url = "http://www.ingentaconnect.com/content/bsc/hed/2008/00000048/00000009/art00010"
	doi = "doi:10.1111/j.1526-4610.2007.01027.x"
}