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Forum Name: Headaches

Question: Positional and Valsalva type headaches


 lindarob - Thu Sep 17, 2009 2:45 pm

Four months ago I woke up with a severe headache that would not go away. It seemed to be off the charts when I would bend over to put on my shoes, sneeze, cough, or valsalva in any way. This has gotten worse over time. After about a month I also started having a numbness between my shoulder blades that has now spread down both arms. Having been diagnosed with polycystic kidney disease, they wanted to rule out any cerebral aneurysms so I have had CT and MRI of which the CT was fine and the MRI showed "Subtle increased FLAIR signal adjacent to the atria of the lateral ventricles. Correlate clinically for evidence of demyelinating disease. Otherwise negative. No evidence of mass." (which I realize can be seen in someone with migraines, or with HTN) I also asked for a cervical spine MRI which showed "mild midline disc bulging at C4-5 and C5-6 resulting in mild central spinal stenosis. No evidence of cord lesion." Could the bulging discs be causing these types of valsalva headaches? Could it be something else? and should we run more tests for anything else?
 Dr.M.Aroon kamath - Thu Dec 03, 2009 10:09 am

User avatar Hi,
Headaches, like many ailments, have aggravating and relieving factors.
Some of them can be aggravated by certain activities such as the 'valsalva maneuver' (forced expiratory effort against a closed glottis), by body position or by exertion.

Based on these facts one of the ways of classifying headaches would be as 'orthostatic' headaches (those which increase on standing erect) and 'non- orthostatic' headaches.

“Valsalva-type maneuvers", including sneezing,straining,coughing, bending, and heavy lifting, can aggravate any type of headache, but exertional headaches are actually provoked by such maneuvers.

Exertional headaches are more frequently associated with intracranial lesions (63%) versus than those that are not (37%), and when no structural cause is detected by imaging, these are referred to as "benign exertional headaches”.

You complain of a headache that is non-orthostatic (exacerbated on bending forward) but, aggravated by valsalva maneuver.This could be a 'sinus headache'.

Finally, i must mention on other type of headache that is being reported more frequently of late, ie; Spontaneous Cerebrospinal Fluid Leak Syndrome (SCSFLS).This is known to initiallly start as a 'non- orthostatic' headache and later progress to an 'orthostatic' headache.

Personally, i doubt if your headache has anything to do with the prolapsed cervical intervertebral discs.
Best wishes!

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