Low pressure headaches caused by spontaneous intracranial hypotension

Scott, Shona; Davenport, Richard

doi:10.1136/bmj.g6219

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…The diagnosis is made based on the synthesis of patient history, clinical findings, cerebrospinal fluid (CSF) examination, and imaging studies. These headaches, which are now well defined in the scientific literature, can be frontal, occipital, frontooccipital or holocephalic in anatomic location (Scott and Davenport 2014 ; Mokri 2014 ). They are often pressure-like, occasionally throbbing, and typically bilateral.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report

Elwood¹,

Dewan²,

Smith³

et al. 2016

SpringerPlus

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BackgroundInjection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid (CSF) leaks and subsequent intracranial hypotension has recently been described. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique.MethodsEight patients with medically refractory headache resulting from intracranial hypotension caused by spinal CSF leaks received epidural injections of combined fibrin glue, autologous blood, and Isovue contrast at the L1—2 vertebral level using intermittent fluoroscopic guidance. Pre-procedure, 1-week post-procedure, and 3-month post-procedure headache pain scores were collected and used for comparison.ResultsThree out of 8 patients reported relief at 1 week, although 1 of these 3 patients had returned to their baseline pain intensity at 3 months. Four patients reported no change at 1 week, though 2 of these patients had reduction of their chronic headache pain at 3 months. A single patient reported increased pain 1 week after the procedure, which persisted at 12 weeks. Overall, 4 out of the 8 patients had decreased pain scores at 3-month follow-up.ConclusionsWe did not achieve a similar frequency of headache resolution as reported in prior original studies. However, a subset of patients did appear to receive substantial benefit from the combined fibrin glue-blood patching procedure. This technique may prove to be useful in medically refractory cases, including those patients who continue to have symptoms despite the prior administration of conventional epidural blood patches.

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Section: Introductionmentioning

confidence: 99%

Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report

Elwood¹,

Dewan²,

Smith³

et al. 2016

SpringerPlus

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“…Conservative treatment of SIH includes bed rest, analgesics, antiemetics, adequate oral or intravenous hydration, intravenous caffeine, theophylline, and use of abdominal binders. 2,17 Steroid therapy, intrathecal saline infusion, epidural blood patch, and fibrin glue injection are the other treatment options, while surgical correction is only reserved for patients with large or persistent leaks. 2,3,8,17 Autologous epidural blood patch offers immediate effect by a tamponade effect produced by the epidural injection of autologous blood that diverts CSF in to the intracranial compartment and delayed effect results from the sealing of CSF leak site.…”

Section: Discussionmentioning

confidence: 99%

“…2,17 Steroid therapy, intrathecal saline infusion, epidural blood patch, and fibrin glue injection are the other treatment options, while surgical correction is only reserved for patients with large or persistent leaks. 2,3,8,17 Autologous epidural blood patch offers immediate effect by a tamponade effect produced by the epidural injection of autologous blood that diverts CSF in to the intracranial compartment and delayed effect results from the sealing of CSF leak site. 18 Fibrin glue injection has been not only tried in patients where an epidural blood patch is not feasible but also in patients with headache refractory to epidural blood patch.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Cause of Chronic Headache in an Adolescent Boy: A Case Report

et al. 2019

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Spontaneous intracranial hypotension (SIH) is an under-diagnosed cause of headache in children and adolescents. SIH results from cerebrospinal fluid (CSF) leak due to breach in the dura mater and the etiology for dural breach is often diverse. We report an adolescent boy who presented with chronic episodic headache that later progressed to daily headache. There was a typical history of worsening of headache on upright position and relief of headache on lying down. He was treated with migraine prophylaxis in another hospital but there was no response. Marfanoid features and brisk deep tendon reflexes were observed on clinical examination. Brain magnetic resonance imaging (MRI) revealed sagging of the brain stem, pachymeningeal enhancement, and tonsillar herniation. MRI of spine myelogram confirmed multiple levels of CSF leak. He was initially managed with supportive measures and fluoroscopic-guided fibrin glue injection. Although child remained symptom-free for the next 6 months, he again developed headache. MRI and computed tomography spine myelogram revealed a meningeal diverticulum in the lumbar spine. He was managed with an autologous epidural blood patch and he has been well since then. In this report, we highlight the clinical and radiological pointers to the presence of SIH in children with recurrent headache.

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“…16 Although 90% of PDPH patients present within first 3 days, presentation could be delayed up to 12 days or if untreated headache can remain with long term CSF leak. 17,18,19,20 Box 2: Common and rare clinical manifestation of CSF leaks 10,15 (These symptoms have been reflected in the International Headache Society (IHS) Diagnostic Criteria (Box 3) caused by low ICP. 4,5,8 ) If the clinical diagnosis of CSF leak has been suspected, radiological investigation and diagnostic studies will greatly facilitate the confirmation of the cause as well as its anatomical location.…”

Section: Clinical Presentation and Diagnosis Of Low Csf Pressure Headmentioning

confidence: 99%

Low CSF pressure headache

Thanthulage¹

2015

Sri Lankan J Anaesthesiol

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Orthostatic headaches following dural puncture are well known to anaesthetists as well as other physicians who perform lumbar punctures. However, due to the progression of medical knowledge and newer diagnostic capabilities, many other causes of low pressure headaches have been recognised. Even though low pressure headache is largely underdiagnosed at present, with increased awareness it may become a common finding in the future. This article includes symptoms, diagnostic problems, and treatment options available for patients with low CSF pressure headache including post dural puncture headaches.

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Low pressure headaches caused by spontaneous intracranial hypotension

Cited by 13 publications

References 17 publications

Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report

Efficacy of epidural blood patch with fibrin glue additive in refractory headache due to intracranial hypotension: preliminary report

An Unusual Cause of Chronic Headache in an Adolescent Boy: A Case Report

Low CSF pressure headache

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