A Case of Brain Sag

By the Editorial Team · Sunday, October 11, 2026

A 62-year-old woman from Dover, Ohio, developed persistent headaches that worsen when standing and improve when lying down, leading to a suspected diagnosis of spontaneous intracranial hypotension caused by cerebrospinal fluid leakage. This case highlights the need for careful evaluation of unusual headache symptoms in older adults, as targeted treatments can effectively relieve these often-misdiagnosed conditions.

A 62-year-old woman from Dover, Ohio, began experiencing persistent headaches in early 2025 that intensified upon standing and subsided when lying down. The pain, described as a gripping sensation around the right side of her head, extending over the ear, face, and neck, represented a significant departure from her previous lack of chronic headache issues.

Initially, her primary care provider, a nurse practitioner, considered the possibility of migraines and prescribed medication intended to alleviate such headaches if taken early. However, due to the patient’s late onset of symptoms and a family history marked by her mother’s ruptured brain aneurysm, the provider ordered a computed tomography (CT) scan of the head to rule out serious underlying conditions. The scan returned normal results, offering some reassurance but failing to identify the headache’s cause.

Exploring other potential contributors to her discomfort, the patient consulted her optometrist, suspecting vision issues might be a factor. While a new glasses prescription was made, it did not alleviate her symptoms. She also received accommodations at her workplace, but the headaches persisted.

The woman’s clinical presentation—headaches worsening upon standing and improving when lying down—points toward a condition known as spontaneous intracranial hypotension (SIH), often caused by cerebrospinal fluid (CSF) leaks. Although her case details beyond initial evaluations were not specified, this diagnosis typically involves a decrease in CSF volume leading to “brain sag,” which can cause pressure-like headaches and other neurological symptoms.

SIH is an uncommon but increasingly recognized cause of new-onset headaches in older adults. Identifying and treating CSF leaks, often through targeted imaging and procedures such as epidural blood patches, can significantly improve symptoms. This case underscores the importance of thorough assessment in atypical headache presentations, especially when common causes are ruled out and family history raises concern for neurological disorders.

This article was reported by synthesizing coverage from multiple independent news outlets to present a balanced, unbiased account. Read about our editorial standards. Spotted an error? Let us know.