Conflict of Interest: None
Trendelenburg Position: A Tool to Screen for the Presence of a Low CSF Pressure Syndrome in Daily Headache Patients
Article first published online: 11 JAN 2008
© 2008 the Authors. Journal compilation © 2008 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 48, Issue 9, pages 1366–1371, October 2008
How to Cite
Rozen, T., Swidan, S., Hamel, R. and Saper, J. (2008), Trendelenburg Position: A Tool to Screen for the Presence of a Low CSF Pressure Syndrome in Daily Headache Patients. Headache: The Journal of Head and Face Pain, 48: 1366–1371. doi: 10.1111/j.1526-4610.2007.01027.x
- Issue published online: 3 OCT 2008
- Article first published online: 11 JAN 2008
- Accepted for publication November 10, 2007.
- low CSF pressure syndrome;
- secondary headache disorder;
- cerebrospinal fluid
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.