Differential Diagnosis for Supine Headache

• Single most likely diagnosis
  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition is characterized by a rapid increase in heart rate and other symptoms that occur upon standing, which can include headaches. The supine position can sometimes alleviate or reduce the severity of these symptoms, but in some cases, it might also trigger or worsen headaches due to various factors such as increased intracranial pressure or other mechanisms related to the syndrome.
• Other Likely diagnoses
  • Sinusitis: Sinus infections can cause headaches that may worsen or improve with positional changes, including the supine position. The mechanism could involve increased pressure or congestion in the sinuses when lying down.
  • Tension Headache: While not typically posturally related, some individuals may experience worsening of tension headaches in the supine position due to muscle strain or other factors.
  • Migraine: Migraines can be triggered by a variety of factors, including positional changes. Some people may experience migraine headaches that are worse or only occur when in the supine position.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Subarachnoid Hemorrhage: Although less common, a sudden, severe headache that occurs or worsens in the supine position could be indicative of a subarachnoid hemorrhage, especially if accompanied by other symptoms like stiff neck, vomiting, or loss of consciousness.
  • Intracranial Hypotension: This condition, often caused by a cerebrospinal fluid leak, can lead to headaches that worsen in the upright position but might also have unique presentations, including worsening in the supine position in some cases.
  • Cervicogenic Headache: While typically related to neck movements, in rare instances, a cervicogenic headache could be exacerbated by the supine position if it involves specific cervical spine structures that are irritated in this position.
• Rare diagnoses
  • Chiari Malformation: This structural defect in the cerebellum can cause headaches and other neurological symptoms, potentially worsening with certain positions, including supine, due to increased pressure on the brainstem or spinal cord.
  • Spontaneous Intracranial Hypertension (Idiopathic Intracranial Hypertension): This condition involves increased pressure within the skull without an apparent cause, which can lead to headaches. The relationship with the supine position might be variable, but it's essential to consider in the differential diagnosis of unusual headache patterns.