Headache secondary to an unusual Valsalva manoeuvre in a migrainous patient with cacosmia.

We present the case of a 48-year old female patient with a history of migraine without aura, who also reported a headache triggered by a Valsalva manoeuvre, peculiarly performed with her head bent forward below her knees. By this position, she could obtain temporary relief from a persistent cacosmia of unknown etiology that had developed about 20 years earlier. A possible pathogenic mechanism for this headache is proposed.