Colloid cysts of the third ventricle are rare intracranial tumors, accounting for 0.5% of intracranial tumors. Colloid cysts represent 2% of gliomas, are more common in men than women, and usually are diagnosed between the third and fifth decades of life. The primary presenting complaint of this disorder is headache. The headaches are described as intermittent, severe and intense, and of short duration and usually are located frontally. The main associated features are nausea and vomiting. The headache can be relieved by lying down, which is unusual for headaches secondary to intracranial tumors. Colloid cysts of the third ventricle are diagnosed by computed tomography or magnetic resonance imaging and treatment is surgical. This rare type of headache disorder is significant because it is associated with sudden death. Recognition of the unusual features of colloid cyst headache may result in decreased mortality in this disorder.

Cluster headaches have always been among the most intriguing of the commonly recognized primary headache syndromes. This clinical interest is related to a number of factors, including the intense but short-lived nature of the pain, its sexual predilection, associated trigeminal autonomic dysfunction, and the remarkable circadian and circannual periodicity of cluster periods. Recent advances in neuroimaging and neuroendocrinology have shed light on the pivotal role of the hypothalamus in the biology of cluster headache. We discuss these revelations, along with current clinical observations in headache and sleep medicine.

Low cerebrospinal fluid (CSF) pressure results in neurologic deficits, of which the most common manifestation is headache. Typically, the headache is postural - and specifically, orthostatic - in presentation. There are three hypotheses to explain the occurrence of headache associated with low CSF fluid. The first is traction on pain-sensitive intracranial and meningeal structures; the second is CSF hypovolemia; and the third is spinal loss of CSF resulting in increased compliance at the caudal end of the CSF space. Spontaneous intracranial hypotension (SIH), once believed to be rare, is now more commonly recognized. It is typically associated with orthostatic headache (although initially it may not be) and one or more other symptoms such as alterations in hearing, nausea, vomiting, neck stiffness, diplopia, and visual field cuts. Magnetic resonance imaging (MRI) of the brain with gadolinium is the first study of choice, which typically reveals diffuse pachymeningeal enhancement and, frequently, cerebellar tonsillar descent and posterior fossa crowding. Epidural blood patch (EBP) is the treatment of choice. Surgery and epidural fibrin glue injection are options for those who fail conservative therapy and/or EBP.

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