The most common reason your head hurts when moving is due to low spinal fluid pressure inside your skull, often linked to a condition called intracranial hypotension.
Understanding Intracranial Hypotension and Positional Headaches
Intracranial hypotension arises from a loss or imbalance of cerebrospinal fluid (CSF). CSF acts as a crucial cushion for your brain and spinal cord within protective membranes called meninges. When CSF levels are low, the brain can sag within the skull, particularly when changing positions (like moving your head), stretching sensitive structures and causing pain. This type of pain is often referred to as a positional headache because it changes depending on your posture.
Common Causes and Symptoms
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CSF Leak: This is the most frequent cause. Leaks can occur spontaneously, after a lumbar puncture (spinal tap), after surgery, or due to trauma.
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Symptoms:
- Headache: Typically worse when upright and improves when lying down.
- Neck pain or stiffness
- Nausea and vomiting
- Dizziness
- Ringing in the ears (tinnitus)
- Changes in hearing
- Sensitivity to light (photophobia)
- Blurry or double vision
Other Possible Causes
While intracranial hypotension is a primary suspect, other conditions can also trigger headaches with movement:
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Muscle Tension Headaches: Tight muscles in the neck and shoulders can refer pain to the head, worsened by movement.
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Cervicogenic Headaches: These originate from problems in the neck, often due to arthritis or injury. Movement can exacerbate the underlying neck issue.
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Migraines: While not always positional, movement can sometimes trigger or worsen migraine pain.
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Sinus Infections: Inflammation in the sinuses can cause pressure and pain that worsens with head movement.
When to Seek Medical Attention
It's important to see a doctor if you experience:
- Sudden onset of a severe headache, especially after trauma.
- Headache accompanied by fever, stiff neck, confusion, or neurological symptoms (weakness, numbness, vision changes).
- Headaches that progressively worsen.
- Headaches that don't respond to over-the-counter pain relievers.
Diagnosis and Treatment
A doctor can perform a neurological exam and may order imaging tests, such as an MRI of the brain and spine, to assess CSF levels and identify any leaks. Treatment for intracranial hypotension often involves:
- Conservative measures: Bed rest, hydration, caffeine.
- Epidural blood patch: A procedure where a small amount of your blood is injected into the epidural space of the spine to seal the leak.
- Surgery: In rare cases, surgery may be needed to repair a CSF leak.
