{"title":"At Home “Tips” for Headache Management: The Use of Self-Trendelenburg to Help Determine the Cause of Worsening Headaches: A Case Series","authors":"Todd D. Rozen","doi":"10.1159/000539615","DOIUrl":null,"url":null,"abstract":"In office use of the Trendelenburg position has been shown to be a beneficial clinical tool to help decipher if a CSF pressure/volume component is part of the underlying etiologic process for a patient’s persistent headache. Utilizing the Trendelenburg position at home could potentially be an additional diagnostic tool for the treating headache physician. Our headache practice has been using at home self-Trendelenburg for the past two years and will present the clinical scenarios in which it seems to be the most helpful utilizing a case series of patients.\nThese include:\n1. In those who just had a lumbar puncture and call for worsening headaches and do not have an obvious orthostatic component. \n2. In those who had a spinal epidural blood patch for a presumed CSF leak and state there was no improvement. \n3. In those who are on daily preventive CSF volume lowering medications and call in with worsening headaches. \n4. In those with known CSF pressure dependent headaches high or low but who are not on daily preventive CSF volume modulatory medications.\n5. In those with a history of migraine or other primary headache disorder to see if a new type of headache is possibly from a CSF leak or an abnormal reset of CSF pressure to an elevated state. \n6. In those with triggered only headaches like cough or exertional headache. \nUtilizing at home self-Trendelenburg can provide valuable information for the treating headache physician on possible underlying headache etiology and can guide specific treatment strategies. Its simplicity and quick declaration of results is very patient pleasing. \n","PeriodicalId":9639,"journal":{"name":"Case Reports in Neurology","volume":null,"pages":null},"PeriodicalIF":0.6000,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Neurology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000539615","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
In office use of the Trendelenburg position has been shown to be a beneficial clinical tool to help decipher if a CSF pressure/volume component is part of the underlying etiologic process for a patient’s persistent headache. Utilizing the Trendelenburg position at home could potentially be an additional diagnostic tool for the treating headache physician. Our headache practice has been using at home self-Trendelenburg for the past two years and will present the clinical scenarios in which it seems to be the most helpful utilizing a case series of patients.
These include:
1. In those who just had a lumbar puncture and call for worsening headaches and do not have an obvious orthostatic component.
2. In those who had a spinal epidural blood patch for a presumed CSF leak and state there was no improvement.
3. In those who are on daily preventive CSF volume lowering medications and call in with worsening headaches.
4. In those with known CSF pressure dependent headaches high or low but who are not on daily preventive CSF volume modulatory medications.
5. In those with a history of migraine or other primary headache disorder to see if a new type of headache is possibly from a CSF leak or an abnormal reset of CSF pressure to an elevated state.
6. In those with triggered only headaches like cough or exertional headache.
Utilizing at home self-Trendelenburg can provide valuable information for the treating headache physician on possible underlying headache etiology and can guide specific treatment strategies. Its simplicity and quick declaration of results is very patient pleasing.
期刊介绍:
This new peer-reviewed online-only journal publishes original case reports covering the entire spectrum of neurology. Clinicians and researchers are given a tool to disseminate their personal experience to a wider public as well as to review interesting cases encountered by colleagues all over the world. To complement the contributions supplementary material is welcomed. The reports are searchable according to the key words supplied by the authors; it will thus be possible to search across the entire growing collection of case reports with universally used terms, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.