A posture-sensitive headache needs a different evaluation

Headache that predictably eases when lying down raises the possibility of low cerebrospinal-fluid pressure and needs specialist review.

Medication-overuse headacheFrequent acute treatments can perpetuate headache in susceptible people.
Migraine with changed patternMigraine frequency and triggers can evolve without a new structural lesion.
Low-CSF-pressure headacheSpinal fluid leakage can produce a characteristic upright-worse pattern.
Raised intracranial pressurePressure syndromes may cause positional headache with visual or pulsatile-ear symptoms.
Cervicogenic or tension-type painNeck mechanisms and muscle pain may coexist with migraine.

Morning or supine headache changes the clinical question

Headache worse supine, especially with visual symptoms, calls for evaluation of pressure-related and other causes.

Migraine with changed patternMigraine frequency and triggers can evolve without a new structural lesion.
Low-CSF-pressure headacheSpinal fluid leakage can produce a characteristic upright-worse pattern.
Raised intracranial pressurePressure syndromes may cause positional headache with visual or pulsatile-ear symptoms.
Cervicogenic or tension-type painNeck mechanisms and muscle pain may coexist with migraine.
Medication-overuse headacheFrequent acute treatments can perpetuate headache in susceptible people.

Medication-overuse headache can develop alongside migraine when acute treatments are taken frequently.

Low-CSF-pressure headacheSpinal fluid leakage can produce a characteristic upright-worse pattern.
Raised intracranial pressurePressure syndromes may cause positional headache with visual or pulsatile-ear symptoms.
Cervicogenic or tension-type painNeck mechanisms and muscle pain may coexist with migraine.
Medication-overuse headacheFrequent acute treatments can perpetuate headache in susceptible people.
Migraine with changed patternMigraine frequency and triggers can evolve without a new structural lesion.

An abrupt or major change in pattern may justify reevaluating an earlier migraine diagnosis rather than just changing tablets.

Raised intracranial pressurePressure syndromes may cause positional headache with visual or pulsatile-ear symptoms.
Cervicogenic or tension-type painNeck mechanisms and muscle pain may coexist with migraine.
Medication-overuse headacheFrequent acute treatments can perpetuate headache in susceptible people.
Migraine with changed patternMigraine frequency and triggers can evolve without a new structural lesion.
Low-CSF-pressure headacheSpinal fluid leakage can produce a characteristic upright-worse pattern.