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Positional headache vs migraine vs medication overuse headache Positional headache (orthostatic or its reverse): Clearly worse in one position (lying down or standing) and better in the opposite position Dull, pressure-like quality across the whole head or back of head No aura, no visual changes Improves within 15-30 minutes of changing position Often worse in the morning after lying flat all night Responds to hydration Migraine: Throbbing, pulsating quality, usually one-sided Moderate to severe intensity Worsened by physical activity Often accompanied by nausea, light sensitivity, sound sensitivity May have aura (visual disturbances, tingling, speech changes) Position changes don't consistently help Responds to triptans or NSAIDs Medication overuse headache: Occurs 15+ days per month Present on waking Dull, bilateral, constant History of frequent analgesic use (acetaminophen, ibuprofen, triptans) Paradoxically caused by the medications used to treat headache Improves only after stopping the overused medication for 2-4 weeks GLP-1-induced nausea headache: Accompanied by nausea, sometimes vomiting Worse after eating or smelling food No clear positional component Improves with anti-nausea medication (ondansetron) Typically resolves within 4-6 weeks of stable dosing The positional pattern is the distinguishing feature

n=141 ALC, n=139 control), the pooled estimate also favored ALC, though the confidence interval included the possibility of no effect (SMD 1.33, 95% CI 2.80 to 0.14

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