Hi all- i will try to keep this short. My 20-year old son developed painful headaches in back of his head in early November. The pattern and type of the pain led his neurologist to diagnose him with occipital neuralgia (irritated occipital nerve). It happened after a very stressful time at school (college student) so we assume it is the result of tight neck muscles. He had his second nerve block this past Friday (first one gave him relief for about 2.5 weeks) and he is on another med for nerve pain.

At the Friday appointment, he happened to mention to the neurologist that when the headaches are really bad he finds relief by laying down (especially on heating pad) and closing his eyes. Also, a hot shower seems to also settle things down. Well, the doctor perked up when he mentioned the "laying down" part and started questioning him about it and then mentioned the postural headaches caused by a leak.

We went back and forth about it but moved forward with the occipital headache treatment. But now, of course, Im wondering if it's something we should follow up?

Does this sound like a spinal fluid leak headache? He does not get a headache upon standing but when he gets a bad "attack" standing is worse and laying down is better. They do generally develop late in the day/evening (which I attributed to using his neck muscles.)

My questions:
If it was due to a leak, would the pain be constant when standing? Also, he was pain free after the first nerve block -would this be the case if the cause was a leak?

His MRI was normal although it was done without contrast

He has NO nausea, dizziness or vision problems.

He went for a short run Friday night and had no pain. Would that even be possible with a CSF leak??

Thank you!! I really don't want to worry about a different diagnosis but I need to gather as much info as I can in order to get him the appropriate care.