What Causes Headaches When Bending Over?

Headaches when bending over can have many causes, such as sinus pressure, coughing, or dehydration. Bending over may also worsen migraines or positional headaches—which intensify with upright posture and tend to improve when lying down.

Most headaches when bending over are not cause for alarm, but some require medical attention. Positional headache in particular an be a sign of more serious underlying cause, such as a leak of cerebrospinal fluid (CSF) cerebrospinal fluid (CSF) that cushions the brain, a heart issue, or a brain tumor.

This article will describe both common and rare causes of a headache when bending over, risk factors, when to see a healthcare provider, and treatment options. 

Common Causes of Headache When Bending Over 

Blood and cerebrospinal fluid (CSF) circulate throughout your brain and spinal cord, providing a certain amount of intracranial pressure (ICP), or pressure within the head, to support and protect the brain and its blood supply. ICP changes with different positions due to gravity's effect on fluid distribution throughout the body. 

When standing upright, ICP naturally decreases due to gravity pulling fluid away from the head. However, when the head is tilted back, inverted, or bent over, ICP increases. This increase in ICP can worsen symptoms of headaches due to the increased pressure within the head.

Some common causes of headache that worsen when bending over include the following.

Sinus Headache

A sinus headache develops from increased pressure within the sinuses (the four pairs of hollow spaces) of the head and face. It usually starts from inflammation caused by a cold or allergies. Increased ICP can aggravate already inflamed sinuses and produce a headache.

Treatments may include over-the-counter pain relievers for headache pain and decongestants or antihistamines to help reduce swelling and congestion. Home remedies like a steamy shower can also help relieve some of the sinus pressure to offer relief.

Dehydration Headache

A dehydration headache results from a lack of fluids within the body, which causes head pain due to inadequate fluid balance. Increased ICP causes a force of pressure within the head, further constricting blood vessels and worsening a dehydration headache. Dehydration can come from vomiting, having diarrhea, or not drinking enough water.

Treatment involves rehydrating with plenty of fluids. Broth and sports drinks with electrolytes can be helpful.

Cough Headache

A cough headache is a sudden headache that occurs after coughing, sneezing, laughing, straining, or bending over. It's caused by the increased pressure that develops within the head and body from the force of these movements.

A cough headache may resolve on its own or may be treated with over-the-counter or prescription nonsteroidal anti-inflammatory pain medications (NSAIDs). See your healthcare provider for an evaluation since it could be that a cough is triggering another type of headache or there may be a more serious underlying condition.

Migraine Headache

A migraine is a neurological condition that can cause a severe throbbing headache, sensitivity to light and sound, nausea, and vomiting. Increased ICP that occurs from bending over will compound the intensity of head pain with migraines.

Migraine treatment often involves a combination of medication and prevention strategies, such as identifying and avoiding triggers (such as foods or activities). OTC NSAIDs, such as Advil (ibuprofen) or Aleve (naproxen), may be helpful for mild to moderate migraines.

Severe or persistent migraines may be treated with triptans, such as Imitrex (sumatriptan) or Maxalt (rizatriptan), or a combination triptan/NSAIDs, such as Treximet (sumatriptan/naproxen).

Positional Headaches

Orthostatic, or positional, headaches occur with upright posture and are usually relieved by lying down. These types of headaches can get worse when bending over.

Positional headaches are rare, affecting about five people in 100,000 each year, but they can have serious underlying causes. Positional headaches are most often caused by a CSF leak in the brain or spine.

They may also sometimes occur as a cervicogenic headache (pain transfers from the neck to the head) or be caused by postural orthostatic tachycardia (rapid heart rate) syndrome or a brain tumor.

CSF Leak

A CSF leak can occur when there is a tear in the outermost layer surrounding the brain (dura mater) or a fracture to one of the bones in the skull. If there is a tear in the dura mater or a skull fracture, CSF can leak out from the brain through the nose and ears. 

In addition to drainage from the nose and ears, a CSF leak can also cause headaches, ringing in the ears (tinnitus), vision problems, and meningitis. These symptoms tend to increase with increased ICP, which can occur from certain positions like bending over.

CSF leaks may also occur after a recent brain surgery or lumbar puncture and result in headaches.

Treatments for a CSF leak may include:

• An epidural blood patch, in which a sample of your blood is injected into the CSF in your spine to circulate and form a clot to seal a CSF leak and decrease symptoms
• Surgery to close a CSF leak

Cervicogenic Headaches

A cervicogenic headache is typically located on one side of the head and neck. "Cervicogenic" means originating from the neck. These headaches often present with decreased range of motion of the neck, or cervical spine, due to muscle tightness. 

Bending over can worsen cervicogenic headaches by increasing irritation and strain on the neck muscles. Poor posture or straining too hard during exercise may contribute to cervicogenic headaches.

Physical therapy, exercise, and lifestyle changes, such as improving your posture and managing stress, can help decrease cervicogenic headaches.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is a condition that causes a significant increase in heart rate (tachycardia) when you transition to an upright position, either from lying down to sitting up or from sitting or bending to standing up. This change in heart rate can also cause headaches, heart palpitations, fatigue, nausea, and fainting.

Treatment for POTS typically includes heart medication to improve heart functioning and reduce symptoms of POTS, as well as lifestyle changes to decrease symptoms, such as:

• Compression garments
• Increased fluid intake
• Exercise
• Avoidance of caffeine, alcohol, and heat exposure

Brain Tumors

Brain tumors are masses of abnormal cells that grow in the brain and may be either benign (noncancerous) or malignant (cancerous). When a postural headache is caused by a brain tumor it may come on gradually, progress over time, and worsen in the morning.

There may be other neurological symptoms such as seizures, difficulty speaking, hearing or vision changes, or personality changes.

Treatment may include surgery to remove the tumor, radiation, and/or chemotherapy.

Diagnosis

To help make a diagnosis, your healthcare provider will ask you about your medical history, including:

• Your headache symptoms
• How long do your headaches last 
• When your headaches started 
• How often your headaches occur 
• If certain conditions trigger your headaches 
• Other medical conditions you may have 

Your healthcare provider will perform a physical examination to assess your neck's movement and range of motion to screen for a possible neurological condition. They may also recommend diagnostic testing to help determine the underlying cause of your headaches. These tests may include:

• Blood work
• Magnetic resonance imaging (MRI) or a computed tomography (CT) scan of the brain
  
• CSF analysis via a spinal tap/lumbar puncture (inserting a hollow needle into the lower spine to withdraw CSF for testing)
• Myelography, a procedure in which a contrast dye is injected into the CSF within your spine and examined using CT scan imaging

If POTS is suspected, your healthcare provider will perform a tilt test. During this test, you will be secured to a flat table that changes positions horizontally and vertically. Your heart rate and blood pressure will be monitored as the table changes positions.

When to See a Healthcare Provider

Common causes of headaches from bending over will subside when the underlying issue, such as a sinus infection or dehydration, is alleviated. They typically do not require further treatment. 

More severe and longer-lasting headaches, such as migraines or positional headaches, often require more treatment. If you have been experiencing ongoing headaches several times a week or month, especially if your headaches have gotten worse over time, schedule an appointment with your healthcare provider to determine the underlying cause and appropriate treatment. 

A Word From Verywell

If the headache changes in intensity in different positions, like standing to lying down, or is triggered by sneezing, coughing, or exercise, it can be concerning. It's important to pay attention to possible warning signs since headaches can be a symptom of something happening in your brain.

— SMITA PATEL, DO, MEDICAL EXPERT BOARD

Headache Prevention

Most common headaches that worsen when bending over can be managed and prevented through lifestyle changes. These include:

• Staying adequately hydrated
• Managing stress
• Getting enough sleep at night
• Limiting exposure to bright screens from phones, tablets, televisions, and computers
• Treating colds and allergies 
• Avoiding migraine triggers like loud noises and bright lights
• Taking pain-relieving medications like nonsteroidal anti-inflammatory drugs (NSAIDs, including Advil or Motrin ibuprofen or Aleve naproxen sodium) or medication prescribed for migraines
  

Summary

A headache when bending over can result from sinus infections, dehydration, coughing, or migraines. Positional headaches that result from a CFL leak can also lead to headaches when bending over.

Most headaches that worsen when bending over can be managed with lifestyle changes like reducing stress, staying hydrated, getting enough sleep, and avoiding triggers like loud noises and bright lights. Medications, physical therapy, epidural blood patching, or surgery may be needed for more involved positional headaches.