A 40-year-old female with a history of migraines reports a severe headache that is worsened by standing up and improved by lying down. What is the likely diagnosis and next steps?
This patient's positional headache that improves upon lying down suggests a diagnosis of spontaneous intracranial hypotension, often due to a cerebrospinal fluid (CSF) leak. The next step should be neuroimaging, likely starting with an MRI brain. If imaging supports the diagnosis, referral to a specialist for potential targeted treatment (like an epidural blood patch) may be necessary.