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A 78-year-old man presented with severe headache for 2 weeks. The headache happened suddenly, thunderclap-like, over his vertex down to occipital region without any accompanying nausea, vomiting, phonophobia, or photophobia. The headache was described as bursting but not pulsatile and it was not related to postural change. He mentioned that his headache would worsen by exertion or other Valsalva-like maneuvers such as straining at stools or coughing. Past history included untreated hypertension and chronic obstructive pulmonary disease treated with xanthium 400 mg per day. Previously, he had also suffered an intermittent mildly tension-type headache over right temporal region for at least 4 years before this episode. This type of headache was controlled by over-the-counters or non-steroidal anti-inflammatory agents. On admission, neurological examination results were normal without papilledema or neck rigidity. Because his headache was very intense and characterized by acute-onset, subarachnoid hemorrhage and/or A B

Exertional but not postural headache resulting from spontaneous intracranial hypotension.