Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

Smita Patel, MD is triple board-certified in neurology, sleep medicine, and integrative medicine.

Several different types of headaches can cause pain when you bend over. Most are not cause for alarm, but some require medical attention.

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

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.

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.

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.

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.

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.

Orthostatic, or positional, headaches are caused by upright posture and are usually relieved by lying down. These types of headaches can get worse when bending over. Positional headaches can result from a CSF leak, cervicogenic headache (pain transfers from the neck to the head), or postural orthostatic tachycardia (rapid heart rate) syndrome.

A CSF leak occurs 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.

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's cervical spine due to muscle tightness. 

Cervicogenic headaches result from muscle irritation in the neck controlled by the C1, C2, and C3 spinal nerve roots. Bending over can worsen cervicogenic headaches by increasing strain on the neck muscles.

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by a significant increase in heart rate (tachycardia) when assuming 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.

General headaches from bending over will subside when the underlying cause, 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. 

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

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:

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.

A general headache that worsens when bending over can be managed and prevented through lifestyle changes. These include:

Treatment for positional headaches will depend on the underlying cause. Options include:

Certain factors increase the risk of developing positional headaches. These include:

Positional headaches from POTS have unique risk factors that include:

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.

A general headache that worsens when bending over can often 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. 

An occasional headache here or there is generally not a cause for concern. You should see your healthcare provider, however, if you have been experiencing ongoing headaches several times per week or month to determine the underlying cause. 

A COVID-19 headache typically presents across both sides of the head rather than localized to one side.

A headache from a brain tumor often causes a constant, dull headache localized to a specific head area and is sometimes accompanied by nausea, vomiting, and seizures.

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