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Symptoms that mean positional headache vs symptoms that mean something dangerous Common positional headache symptoms (typical, manageable): Dull pressure or ache across forehead, temples, or back of head Clearly worse when lying flat, improves when sitting or standing (or vice versa) Worse in the morning after sleeping flat No visual changes, no neurological symptoms Improves within 30 minutes of position change Improves with hydration over 24-48 hours Symptoms that suggest something more serious: Sudden severe headache ("thunderclap headache") reaching maximum intensity within seconds to minutes