Differential Diagnosis for Headaches with Positional Changes
- Single Most Likely Diagnosis
- Orthostatic headache: This is the most likely diagnosis, as headaches that worsen with positional changes are a hallmark of orthostatic headache, often related to a low cerebrospinal fluid (CSF) volume or pressure.
- Other Likely Diagnoses
- Migraine: Some migraines can be triggered or worsened by positional changes, making this a plausible diagnosis.
- Tension headache: Although less common, tension headaches can occasionally be exacerbated by positional changes.
- Cervicogenic headache: Headaches originating from the cervical spine can be influenced by changes in posture or position.
- Do Not Miss Diagnoses
- Subarachnoid hemorrhage: Although less likely, a sudden, severe headache that worsens with positional changes could be indicative of a subarachnoid hemorrhage, which is a medical emergency.
- Spinal epidural hematoma: A rare but potentially life-threatening condition that could present with positional headaches.
- Intracranial hypotension due to a CSF leak: This condition can cause headaches that worsen with standing and improve with lying down, making it crucial not to miss.
- Rare Diagnoses
- Chiari malformation: A structural defect in the cerebellum that can cause headaches, among other symptoms, which might be influenced by positional changes.
- Pseudotumor cerebri (Idiopathic Intracranial Hypertension): Although headaches are typically worse in the morning and with coughing or straining, some patients might experience worsening with positional changes.
- Arteriovenous malformation (AVM): A rare vascular anomaly that could potentially cause headaches influenced by positional changes, although this is less common.