What should you know about tension headache when standing up?

Tension-type pain is often pressure or tightness involving the forehead, temples, scalp, neck, or shoulders. Standing can make you notice pain because of a change in circulation, dehydration, prolonged sitting, muscle strain, or a drop in blood pressure. The posture link may also be coincidental. Record whether the pain starts immediately, settles after sitting or lying down, and comes with light-headedness, blurred vision, palpitations, nausea, or faintness.

A clinician may ask about fluids, meals, recent illness, bleeding, medicines, sleep, and blood-pressure symptoms. Do not assume that every positional headache is a tension-type headache.

Rise slowly from sitting or lying down, hold a stable surface, and sit or lie back if you feel faint. Drink fluids and avoid skipping meals. Keep your neck supported and release jaw or shoulder tension. Avoid driving, climbing, or operating equipment while dizzy. Note the position, timing, duration, food and fluid intake, and any other symptoms. Arrange a GP consultation if this keeps happening, particularly after starting a medicine or during an illness.

Seek urgent help for fainting, chest pain, severe breathlessness, a sudden severe headache, new weakness or numbness, confusion, trouble speaking, loss of vision, seizure, fever with a stiff neck, or a headache after injury. Prompt assessment is also needed when standing-related pain is new and severe, rapidly worsening, or accompanied by repeated vomiting or difficulty walking.

Ask whether your symptoms suggest postural blood-pressure changes, dehydration, a medication effect, neck tension, or another headache pattern. Ask whether blood pressure should be checked lying and standing, and which symptoms would require urgent review.