HomeAnswersNeurologyheadacheWhen lying on my stomach and propping my head up with my elbows, I experience intense head pressure. What could be the reason?

Why do I experience intense pain while propping my head with the elbows?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hitesh Kumar

Medically reviewed by

iCliniq medical review team

Published At August 9, 2022
Reviewed AtAugust 8, 2023

Patient's Query

Hi doctor,

When lying on my stomach and propping my head up with my elbows, I experience intense head pressure. I feel like my head will explode and pass out. I also get a whooshing sound in my ears and tunnel vision. This occasionally happens when standing up from a seated position. Kindly help.

Answered by Dr. Hitesh Kumar

Hello,

Welcome to icliniq.com.

I would like to know some details about your symptoms:

1. Since when did you start to have these headaches?

2. What type of headache do you feel? For example- stretching, heaviness, bursting, burning, pinprick, or something else?

3. What is the intensity of headache - severe, moderate, or mild?

4. In one episode, how long does the headache lasts?

5. Is it associated with nausea or vomiting?

6. Does it gets relieved soon if you lay down that time?

7. Do you have a fever?

8. Is there any rhinorrhea, ear discharge, or hearing abnormality?

9. Does the whooshing sound in the ears and tunnel vision only occur at the time of headache, or do they happen at other times from headache?

10. Have you ever undergone computed tomography (CT) or magnetic resonance imaging (MRI) brain scans for these symptoms?

11. Are you on any medications already? If yes, please give details.

Investigations to be done

MRI brain with contrast including bilateral inner ear sections and cerebrospinal fluid (CSF) flow study. MRI whole spine.

Differential diagnosis

Intracranial hypotension.

Regarding follow up

Review the above-mentioned information for better understanding and further judgment.

Patient's Query

Hi doctor,

Here are my answers to your questions-

1. Since when did you start to have these headaches?life.

2. What type of headache do you feel? For example- stretching, heaviness, bursting, burning, pinprick, or something else?

3. What is the intensity of headache - severe, moderate, or mild?

4. In one episode, how long does the headache lasts?

5. Is it associated with nausea or vomiting?

6. Does it gets relieved soon if you lay down that time?

7. Do you have a fever?

8. Is there any rhinorrhea, ear discharge, or hearing abnormality?

9. Does the whooshing sound in the ears and tunnel vision only occur at the time of headache, or do they happen at other times from headache?

10. Have you ever undergone computed tomography (CT) or magnetic resonance imaging (MRI) brain scans for these symptoms?

11. Are you on any medications already? If yes, please give details.

Answers -

1. My whole life.

2. Bursting headache.

3. Severe pain.

4. Headache lasts until I can lay down on my back.

5. No.

6. Relief after a few minutes of laying down on my back.

7. No.

8. No.

9. It only happens when I get a headache.

10. No.

11. Effexor XR, but only for a year.

Thank you.

Answered by Dr. Hitesh Kumar

Hello,

Welcome back to icliniq.com.

As per your description, it seems to be a strong possibility of intracranial hypotension. I would like to know for which problem you are on tablet Effexor XR (Venlafaxine). Better assessment can be done if you answer the following questions:

1. Are you taking it for this headache itself? Or for something else?

2. What do you mean by whole life? Since what age have you noticed this headache pattern?

3. Did you have any head injuries before the start of these symptoms?

Investigations to be done

Contrast-enhanced magnetic resonance imaging (CE-MRI) brain with cerebrospinal fluid (CSF) flow study. CE-MRI whole spine. Ophthalmological examination to look for refraction, intraocular pressure, and fundus. Blood pressure (BP) measurement charting (twice daily) - supine and standing for one minute and Standing for three minutes. If the diagnosis remains in doubt, I suggest a plan for lumbar puncture and measurement of CSF opening pressure with CSF biochemistry.

Preventive measures

You must drink plenty of fluids and can have coffee.

Regarding follow up

Review with further evaluation details.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hitesh Kumar
Dr. Hitesh Kumar

Neurology

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