Dizziness and Headache Upon Standing: Differential Diagnosis and Next Steps

Orthostatic dizziness with brief headache suggests transient cerebral hypoperfusion. Key etiologies:

1. Orthostatic Hypotension – SBP drop ≥20 mmHg or DBP ≥10 mmHg within 3 min of standing. Causes: volume depletion, autonomic neuropathy, medications (diuretics, α‑blockers, antidepressants).
2. Dehydration – Reduced intravascular volume → inadequate venous return.
3. Anemia – Low O₂‑carrying capacity → cerebral hypoxia on positional change.
4. Vestibular Disorders – BPPV, vestibular migraine, labyrinthitis triggered by head movement.
5. Hypoglycemia – Especially in insulin‑treated diabetes; adrenergic symptoms + neuroglycopenia.
6. Medication Side Effects – Antihypertensives, vasodilators, psychotropics.
7. Cardiac – Arrhythmia, outflow obstruction, diastolic dysfunction.
8. Neurologic – Parkinson’s, MSA, MS, cervical myelopathy.

Recommended Workup

• Orthostatic vitals (supine → 1, 3 min standing).
• CBC, BMP, HbA1c, TSH, iron studies.
• ECG ± Holter; echocardiogram if cardiac suspicion.
• Medication review – taper/offending agents.

Self‑diagnosis is unsafe; see a clinician for targeted evaluation.