From the Guidelines
Medications that can cause orthostatic headaches include those that affect cerebrospinal fluid production or absorption, such as carbonic anhydrase inhibitors like acetazolamide, which can cause orthostatic headaches at doses above 500mg per day 1.
Medications Associated with Orthostatic Headaches
- Spinal anesthesia medications like lidocaine, bupivacaine, and fentanyl
- Intrathecal chemotherapy agents like methotrexate and cytarabine
- Pain management medications like epidural steroid injections, particularly with doses of triamcinolone above 40mg or methylprednisolone above 60mg
- Certain antibiotics like intrathecal penicillin and ceftriaxone
- Medications that affect cerebrospinal fluid production or absorption, such as carbonic anhydrase inhibitors like acetazolamide, which can cause postural headaches at doses above 500mg per day 1.
It's essential to note that the risk of orthostatic headaches can vary depending on the specific medication, dose, and duration of treatment, as well as individual patient factors, and some medications like ergotamine, opiates, triptans, and simple and mixed analgesics containing butalbital, caffeine, or isometheptene can cause rebound headache 1. If you are experiencing orthostatic headaches, consult your healthcare provider to discuss potential causes and treatment options.
From the FDA Drug Label
Fentanyl is an opioid analgesic. ... At therapeutic dosages, fentanyl usually does not exert major effects on the cardiovascular system. However, some patients may exhibit orthostatic hypotension and fainting
- Orthostatic hypotension is a condition that can cause headaches when standing up.
- The medication that may cause orthostatic headaches is fentanyl (IT), due to its potential to cause orthostatic hypotension. 2
From the Research
Orthostatic Headaches and Medications
- There is limited information available on medications that cause orthostatic headaches in the provided studies.
- However, some studies mention post-dural puncture headache (PDPH) and post-lumbar puncture headache (PLPH) as complications of lumbar puncture procedures, which can be related to orthostatic headaches.
- The studies suggest that the incidence of PDPH and PLPH can be influenced by factors such as the type of spinal needle used, patient age, and the presence of underlying medical conditions 3, 4, 5, 6, 7.
Post-Dural Puncture Headache (PDPH)
- PDPH is a well-known complication of lumbar puncture, characterized by a headache that worsens in the upright position and improves in the supine position 3, 6, 7.
- The incidence of PDPH can range from 4.5% to 8% depending on the type of spinal needle used 3.
- PDPH can be treated conservatively, and in some cases, may require further evaluation and treatment, such as a blood patch 4, 6.
Medications and Orthostatic Headaches
- Nusinersen, an antisense oligonucleotide drug administered intrathecally, has been associated with adverse events, including headache, in clinical trials 5.
- However, it is unclear whether nusinersen or other medications can cause orthostatic headaches directly.
- Further research is needed to determine the relationship between medications and orthostatic headaches.