Supplementary Material for: At Home “Tips” for Headache Management: The Use of Self-Trendelenburg to Help Determine the Cause of Worsening Headaches: A Case Series

In office use of the Trendelenburg position has been shown to be a beneficial clinical tool to help decipher if a CSF pressure/volume component is part of the underlying etiologic process for a patient’s persistent headache. Utilizing the Trendelenburg position at home could potentially be an additional diagnostic tool for the treating headache physician. Our headache practice has been using at home self-Trendelenburg for the past two years and will present the clinical scenarios in which it seems to be the most helpful utilizing a case series of patients.
These include:
1. In those who just had a lumbar puncture and call for worsening headaches and do not have an obvious orthostatic component.
2. In those who had a spinal epidural blood patch for a presumed CSF leak and state there was no improvement.
3. In those who are on daily preventive CSF volume lowering medications and call in with worsening headaches.
4. In those with known CSF pressure dependent headaches high or low but who are not on daily preventive CSF volume modulatory medications.
5. In those with a history of migraine or other primary headache disorder to see if a new type of headache is possibly from a CSF leak or an abnormal reset of CSF pressure to an elevated state.
6. In those with triggered only headaches like cough or exertional headache.
Utilizing at home self-Trendelenburg can provide valuable information for the treating headache physician on possible underlying headache etiology and can guide specific treatment strategies. Its simplicity and quick declaration of results is very patient pleasing.

临床诊室中使用的特伦德伦伯卧位（Trendelenburg position）已被证实为一项有益的临床工具，可用于鉴别患者持续性头痛的潜在病因是否与脑脊液（Cerebrospinal Fluid, CSF）压力或容量异常相关。在家中使用特伦德伦伯卧位，或可为接诊头痛的临床医师提供额外的诊断手段。本头痛专科团队在过去两年中已应用居家自主特伦德伦伯卧位操作，并将通过一组患者病例系列，展示该操作最具应用价值的临床场景。
该类场景包括：
1. 刚完成腰椎穿刺（lumbar puncture）后主诉头痛加重，且无明确直立性诱因的患者；
2. 因疑似脑脊液漏接受脊髓硬膜外血贴（spinal epidural blood patch）治疗后，主诉头痛无改善的患者；
3. 规律服用降低脑脊液容量的预防性药物，但仍主诉头痛加重的患者；
4. 已知存在脑脊液压力异常（升高或降低）相关性头痛，但未规律服用调节脑脊液容量的预防性药物的患者；
5. 既往有偏头痛或其他原发性头痛病史，需鉴别新发头痛是否由脑脊液漏或脑脊液压力异常升高重置所致的患者；
6. 仅在触发因素（如咳嗽、用力活动）下出现头痛的患者。
居家自主特伦德伦伯卧位操作可为接诊头痛的临床医师提供关于潜在头痛病因的重要信息，进而指导针对性治疗方案的制定。该操作简便易行且可快速获得结果，患者接受度极高。