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High and low pressure headaches: a spinal cause
  1. Grace Petkovic1,
  2. Elizabeth Rose-Innes1,
  3. Stana Bojanic2,
  4. Maria Isabel Leite3,
  5. Benjamin R Wakerley3,4
  1. 1Oxford University Medical School, Oxford, UK
  2. 2Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  4. 4Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  1. Correspondence to Dr Benjamin R Wakerley, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 2EL, UK; benwakerley{at}

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Case history

A 25-year-old woman gave a 3-year history of worsening headaches related to posture. She had Marfan’s syndrome and a background of infrequent migraine.

She defined two types of headache:

  • A ‘high pressure’ headache invariably developed if she lay flat for more than a few minutes, and improved on sitting or standing. Typically, these headaches developed over 1–2 min and were generalised without migrainous features. There was no change in vision, but sometimes she heard whooshing noises. Leaning forward when seated or the Valsalva manoeuvre could trigger similar symptoms.

  • A different ‘non-high pressure’ generalised headache was often triggered by moving to standing from lying or sitting. These headaches also developed rapidly, sometimes over a few seconds and would often improve over a few minutes if she …

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