Rebound high-pressure headache after treatment of spontaneous intracranial hypotension

Abstract

BackgroundRebound high-pressure headaches may complicate treatment of spontaneous intracranial hypotension (SIH), but no comprehensive study of such patients has been reported and little is known about its frequency and risk factors. We therefore studied patients undergoing treatment for SIH and performed magnetic resonance venography (MRV) to assess for cerebral venous sinus stenosis, a risk factor for idiopathic intracranial hypertension.MethodsWe studied a consecutive group of patients who underwent treatment for SIH. Rebound high-pressure headache was defined as a reverse orthostatic headache responsive to acetazolamide. MRV was obtained in all patients and lateral sinus stenosis was scored according to the system published by Higgins et al., with 0 being normal and 4 signifying bilateral signal gaps.ResultsThe mean age of the 46 men and 67 women was 45.9 years (range 13–71 years) at the time of onset of SIH. Rebound high-pressure headache was diagnosed in 31 patients (27.4%); 14% of patients with an MRV score of 0, 24% with a score of 1, and 46% with a score of 2 or 3 (p = 0.0092). Also, compared to SIH patients who did not develop rebound high-pressure headaches (n = 82), those with rebound high-pressure headaches were younger, more often female, and more often had an extradural CSF collection on spinal imaging.ConclusionsRebound high-pressure headache occurs in about one-fourth of patients following treatment of SIH and is more common in those with restriction of cerebral venous outflow.

Early and Delayed Rebound Intracranial Hypertension Following Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension: A Case Report

“…In most RIH cases reported, the onset of symptoms has been rapid (from immediate to three days) and papilledema has been rarely reported, possibly due to the appearance of the usual fundoscopic changes over a period of days to weeks. The CSF opening pressure measurement in these patients ranged from 20 to 55 cm H 2 O [7,18,19].…”

Early and Delayed Rebound Intracranial Hypertension following Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension

“…In most RIH cases reported, the onset of symptoms has been rapid (from immediate to three days) and papilledema has been rarely reported, possibly due to the appearance of the usual fundoscopic changes over a period of days to weeks. The CSF opening pressure measurement in these patients ranged from 20 to 55 cm H 2 O [ 7 , 18 , 19 ].…”

Idiopathic intracranial hypertension – a wider spectrum than headaches and blurred vision

“…The most common scenario is that a (sub)occipital SIH headache transforms to a frontal high-pressure headache. 12 , 13 Most patients also have new nausea and/or vomiting and complain of new blurred vision. 13…”