headache seems to be worse when laying down -- CSF pressure too high?

[Citizen T]

I actually was diagnosed with a benign 3.5 centimeter bone tumor in the frontal bone 4 years ago, it has been followed with regular scans and hasn't changed since it was discovered.    Usually, I have a constant moderate dull pressure deep behind my forehead...it doesn't throb or get worse with activity.    My doc says that it's pretty clear the cause of my symptoms but I've turned down the surgery option.     However,  my question is about this,  here lately I seem to have a worse, throbbing headache that lingers on for sometimes days at a time.   Sometimes my head feels peculiar, like a mild electric buzzing inside and increasing to this throbbing pain.     Quite often, I wake up in the morning,  or even get woken up early by terrible throbbing pain in my head,  and when I get out of bed it immediately improves by 50% but does certainly not go away,  it will linger for many hours or even days.    Other times, if I just lay down for a nap, and especially if I lay on my stomach, or bend over forward to too long,  I develop this throbbing headache,  and it does not go away when I stand back up, but does improve slightly when I stand up.      My last dilated eye exam, 3 months ago, was normal,   and last month, the doctor looked in my eyes (non dilated) and both events were normal exams.      Could I have a mildly elevated CSF pressure causing this,  even with a normal eye exam?    Do you think this is not likely?   What can this be,   that my headache is changing for the worse,  but my tumor is not growing and I don't have papiladema?

[Citizen T]

Ah, yes, thank you for your reply.  I did have a normal sleep study as this was one thing my doctor thought of.   I wonder what to do now

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

In general, not in your case in particular, but in general, a headache that is triggered by prolonged lying down, such as a morning headache, could be a sign of increased pressure in the brain (what is medically termed increased intracranial pressure or ICP). Such headaches typically improve after sitting or standing for some time. However I can not judge whether or not this is the cause of your headaches; a frontal bone tumor would be unlikely to cause increased ICP if it is the size you mention, unless it is somehow protruding into the intracranial space and pressing on the brain or the area where the cerebrospinal fluid flows (leading to what is termed hydrocephalus). The normal eye findings makes the increased ICP less likely.

One other potential cause of morning headaches is completely unrelated: it is sleep apnea. This is a condition in which there is poor ventilation at night. The most common cause is obstructive sleep apnea, which is when the upper airway is narrowed for whatever reason, so that breathing is impaired at night. Most often this occurs in overweight people, and the typical history is snoring with periods of grunts or apneas (periods when breathing stops) and with awakenings however very thin people with short necks or narrow throats can experience this too. The typical story is morning headache and daytime sleepiness. This would best be evaluated by a sleep study (a polysomnogram).

Another cause of morning headaches is muscular: poor sleeping position leading to tightness of neck muscles, which can then cause headache, what is termed cervicogenic headache (headache coming from the neck region).

Other causes of morning headache are teeth grinding (medically called bruxism), which leads to irritation of the TMJ and pain particularly around the temples.

Continued follow-up with your neurologist is recommended.

Thank you for using the forum I hope you find this information useful good luck.