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Postural headaches...beyond the dural puncture

Most clinicians focus on postural symptoms as the hallmark of low CSF pressure. However, postural or exertional factors may be noted in conditions other than that of low CSF pressure. Obstructions to ventricular CSF flow, Arnold-Chiari malformation type 1, subdural hematomas, cerebral venous thrombosis, and sinus disease can all lead to positional and postural headache. Reactive brain edema (causing slit ventricles) may displace brain tissue downward, accounting for Arnold-Chiari type 1 findings.

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