Headache caused by straining

摘要

A 62 year-old, previously well, Caucasian woman presented to hospital with an acute onset, moderate intensity headache after lifting a heavy object while bending down. The headache lasted 15 minutes and was bilateral over the vertex, without photophobia, motion sensitivity, nausea or autonomic symptoms. As she had previously never had headaches, she sought medical attention. Neurological examination was normal, CT brain illustrated no acute bleed and magnetic resonance angiogram (MRA) was normal. A magnetic resonance imaging (MRI) scan showed type 1 Arnold-Chiari malformation (Fig 1) (the position of the cerebellar tonsils can be seen below the foramen magnum). A normal MRI scan (Fig 2) is shown for comparison.