Spontaneous intracranial hypotension: uncommon but important.

A 44-year-old woman presented with sudden onset of occipital headache and neck stiffness for 3 weeks. The headache was pulling in character and worse in the morning (visual analogue scale pain score of 8). Coughing, straining when passing a stool, and postural change (either going from a lying to an erect position or vice versa) provoked the headache. It was associated with vertigo, nausea, and vomiting. She gave no history of trauma to her head and neck and had not experienced any fever, rashes, photophobia, tinnitus, or deafness. She did, however, notice night sweats, anorexia, and subjective weight loss. She had undergone LASIK for myopia and her medical history was otherwise unremarkable. She did not use oral contraceptive pills.