title: Treatment of orthostatic headache without intracranial hypotension: a case report.
abstract: BACKGROUND
  Orthostatic headache is very suggestive of intracranial hypotension. It has a good prognosis as it usually responds to conservative treatment or epidural blood patches.
  
  
  METHODS
  A 36-year-old female presented with severe and prolonged orthostatic headache starting after a seizure. No stigma of intracranial hypotension was detected on brain MRI, and intracranial pressure was within normal range. No imaging evidence of a fistula was found. She was refractory to symptomatic treatment including five epidural blood patches. Progressive improvement occurred simultaneously to the introduction of vitamin A supplementation.
  
  
  CONCLUSIONS
  A series of six similar patients is discussed, in which five patients remained severely symptomatic and workdisabled at an average follow-up of four years. It is proposed that the pathophysiological mechanism producing orthostatic headache might not be dependent on intracranial hypotension and could respond to vitamin A.
authors.affiliation: Headache Center, Hospital da Luz, Portugal. rgouveia@hospitaldaluz.pt
authors.forename: Raquel
authors.initials: R
authors.lastname: Gil-Gouveia
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D015673:Fatigue Syndrome, Chronic / Q000150:complications; D005260:Female; D006261:Headache / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019585:Intracranial Hypotension; D050177:Overweight / Q000150:complications; D012640:Seizures / Q000150:complications; D014801:Vitamin A / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D014801:Vitamin A
keywords: Orthostatic headache; intracranial hypotension; vitamin A