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Headache worse lying down (the more common GLP-1 pattern): Suggests relative CSF volume depletion Brain is inadequately cushioned Lying down increases intracranial pressure, stretching pain-sensitive structures Standing allows CSF to drain, reducing pressure Fix: hydration to restore CSF volume Headache worse standing up (less common, but possible): Suggests CSF leak or severe volume depletion Brain sags downward when upright due to inadequate CSF support Lying down allows the brain to float properly again Standing creates traction on meninges and cranial nerves Fix: aggressive hydration, possible imaging to rule out CSF leak The GLP-1 pattern is usually the first type (worse lying down) because the mechanism is relative hypervolemia when supine in the context of chronic mild dehydration

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