orthostatic headache Its causes and treatment

orthostatic headache، Common in the elderly, people taking medications for circulatory diseases or poorly nourished, orthostatic hypotension represents a risk if we take into account that it can cause fainting, falls and general malaise that prevents the realization of activities.

When talking about alterations in blood pressure it is common to think of cases in which it rises (hypertension) when playing sports, feeling nervous, living a stressful situation or as a permanent circulatory problem (chronic) that occurs in some people. However, the tension exerted by the blood on veins and arteries can also fall from their normal levels, for example, when someone who was lying down sits or stands up, causing fading.

orthostatic headache

This condition is called by orthostatic or postural hypotension specialists , and is due to the lack of force in the pumping of the blood prevents it from reaching the brain properly and supplying oxygen and nutrients. Although in most cases it is a temporary problem, it should be evaluated as soon as possible by the family doctor or geriatrician to determine its origin and prevent these episodes from continuing, since they can generate severe accidents or indicate a serious illness .

Failure in self-regulation

The blood pressure is not more than the force exerted by blood on the inner walls of arteries and veins. To assess its status, two numbers are used, divided by a diagonal, which are measured in millimeters of mercury (mmHg) and represent, in order, the maximum or systolic tension, which is generated when the heart beats, and the minimum or diastolic, which occurs during pauses between cardiac contractions.

Normal pressure figures allow blood to circulate properly and, in accordance with most medical criteria, correspond to 120/80 mmHg in adults. In contrast, hypotension is considered to occur when it drops to 110/75 mmHg or less, although generally a slightly lower number is required for symptoms to be generated.

The particular case of postural hypotension responds to a well-studied and well-known phenomenon. When a person at rest sits or stands up abruptly, the force of gravity causes much of his blood to travel to his legs, arms and trunk, so that the amount of fluid that can pump his heart is reduced, decreasing his pressure arterial.

Under normal conditions, the agency has resources that avoid this problem; For example, the heart beats faster, the contractions are more powerful and the arteries contract so that the space through which the blood circulates is smaller and more tension is generated. On the other hand, when these reactions fail or are very slow, orthostatic hypotension occurs .

People with this problem experience, for the most part, fainting , mild dizziness , confusion or blurred vision when they stand up quickly or enter into activity after being inactive for prolonged periods; also, it is known that fatigue, exercise, alcohol consumption or a hearty meal can accentuate these symptoms. If the reduction of blood flow to the brain is very pronounced, fainting (syncope or loss of consciousness ) and even convulsions (strong and involuntary shaking) may occur.

There are different causes of postural hypotension , the main ones being:

Old age. It is known that there are people whose autonomic nervous system, which is responsible for coordinating involuntary reactions such as preventing the fall of blood pressure when standing up , suffers atrophy with the passage of time and stops acting as quickly as before.

Consumption of drugs. Medications that are administered to eradicate problems such as hypertension and depression can affect the normal reactions of the body, generating hypotension .

Dehydration . The low amount of water in the body borders the blood has a smaller volume and, therefore, generate weaker pressure on veins and arteries. The causes of this problem can be diarrhea, vomiting, excessive sweating, prolonged exposure to the Sun (heat stroke) and abuse of diuretics (medicines that promote the expulsion of urine).

Malnourishment . The lack of adequate nutrition causes the blood to be poor in nutrients, while affecting the neural networks responsible for maintaining stable blood pressure.

Alcoholic drinks. Its prolonged consumption alters or inhibits the general functioning of the nervous system.
Diabetes . The excess blood sugar that characterizes this disease causes neuropathy, that is, it can atrophy the nerve endings responsible for controlling blood pressure.

Addison’s disease It is a deficiency in the functioning of the adrenal glands (located on the kidneys) that alters the circulatory process.
Injuries in the spinal cord. Accidents, bumps and falls can hurt the nerves, preventing the regulation of blood pressure.

Heart diseases. Those who have problems such as tachycardia (irregular heart palpitations) or insufficiency (inability of the heart muscle to distribute blood properly) are more likely to suffer from this problem.

Degenerative diseases of the nervous system or neurodegenerative. Parkinson’s disease (disorder characterized by tremor and difficulty coordinating movements) and Shy-Drager syndrome or multisystem atrophy (similar to Parkinson’s, but more severe and with damage focused on the autonomic nervous system) are some of the conditions that are characterized by Progressive atrophy of neuronal tissues, and it is common that they generat

postural hypotension .

The group most vulnerable to this problem is undoubtedly that of the elderly, not only because their nervous system acts less quickly than before, but because it is known that many elderly people eat poorly, drink little water , consume medications to regulate their pressure and suffer more often diabetes or degenerative diseases of the nervous system. If we add to this the latent risk that the person falls and has a hip fracture when suffering a fading, it is essential that every elder who has presented hypotension, even occasionally, comes to evaluation.

Favorable diagnosis, almost always

The family doctor or geriatrician is able to detect orthostatic hypotension only with knowing the symptoms that the patient reports, but in addition to interviewing him and elaborating his history, he must take several times the blood pressure in the office, both when he is at rest and after getting up. , in order to ratify the diagnosis.

In any case, it is also important to carry out some studies that allow to delimit or rule out the cause of this condition, among them urinalysis, blood studies and possibly some spine radiography.

The measures to follow in the treatment will vary considerably, depending on the case:

In those patients where orthostatic hypotension is due to the consumption of a drug, the disorder can be corrected quickly by adjusting the dose or changing the medication.
When there is a decrease in the blood volume due to dehydration , the consumption of larger amounts of water and salts will be required; In the case of the elderly, it is advisable to avoid long hours under the Sun and excessive efforts.
People with malnutrition should try to maintain a balanced diet in which preference is given to fruits, vegetables, whole grains, fish and white meats. The doctor is likely to advise a multivitamin for a period of time.

If the cause is atrophy in the nerve endings due to diabetes (diabetic neuropathy), the prognosis is bad, since this indicates that other organs may be severely affected, especially the kidneys. It indicates the practice of exercise, change of diet (rich in vegetables and low in fat, sugar and refined flours) and, probably, use of hypoglycaemic drugs (help to lower the concentration of glucose in blood) administered by the endocrinologist.

Those who suffer from circulatory problems should be referred to the cardiologist, who will make a deeper assessment of their case. In general terms, the problem should be treated with a diet low in fat, red meats and refined flours, and rich in vegetables; the practice of mild exercise is usually favorable, as well as the moderation in salt intake.
The diagnosis is unfavorable in case of Parkinson’s disease, Shy-Drager syndrome or neuronal diseases, since until now no cure has been found for them. The treatment can only control or lessen the symptoms.
Those people where the autonomic or involuntary nervous system fails to regulate the pressure due to old age or after suffering an accident, it is practically impossible to eradicate the problem. However, some measures can be taken:

Patients should be careful not to sit up or stand up suddenly, or remain immobile for a long time.
Since postural hypotension can be generated by blood accumulation in the legs, elastic compression stockings can be useful.
It is essential to drink plenty of fluids and eradicate alcohol consumption, as well as eating a balanced diet.
If you do not have circulatory diseases (heart failure or high blood pressure), the patient can add salt to their meals freely, in order to retain more liquid in the blood.