Nonpositional headache caused by spontaneous intracranial hypotension

A 68-year-old man awoke with a headache and a whirring noise in both ears. There was no history of trauma. The headache was bifrontal and associated with nausea and posterior neck pain. The headache was nonpositional, e.g., it did not worsen upon standing or improve when lying down. Because the headache persisted and would occasionally awake him from sleep, he sought advice 1 month after the onset of symptoms. He had a history of coronary artery disease. Neurologic examination was normal. Brain MRI showed bilateral chronic subdural hematomas, a sagging brain, and diffuse pachymeningeal enhancement (figure A through C). Coagulation studies were normal. The subdural hematomas were believed to …