Headache Secondary to Intracranial Hypotension

  • Wouter I. Schievink
  • Constance R. Deline
Secondary Headache (K Henry and M Robbins, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Secondary Headache


Intracranial hypotension is known to occur as a result of spinal cerebrospinal fluid (CSF) leaking, which may be iatrogenic, traumatic, or spontaneous. Headache is usually, but not always, orthostatic. Spontaneous cases are recognized more readily than in previous decades as a result of a greater awareness of clinical presentations and typical cranial magnetic resonance imaging findings. An underlying disorder of connective tissue that predisposes to weakness of the dura is implicated in spontaneous spinal CSF leaks. CT, MR, and digital subtraction myelography are the imaging modalities of choice to identify spinal CSF leakage. Spinal imaging protocols continue to evolve with improved diagnostic sensitivity. Epidural blood patching is the most common initial intervention for those seeking medical attention, and may be repeated several times. Surgery is reserved for cases that fail to respond or relapse after simpler measures. While the prognosis is generally good with intervention, serious complications do occur. More research is needed to better understand the genetics and pathophysiology of dural weakness as well as physiologic compensatory mechanisms, to continue to refine imaging modalities and treatment approaches, and to evaluate short- and long-term clinical outcomes.


Cerebrospinal fluid leak CSF leak Epidural blood patch Orthostatic headache Spontaneous intracranial hypotension Spontaneous spinal CSF leak 


Compliance with Ethics Guidelines

Conflict of Interest

Dr. Wouter I. Schievink and Dr. Constance R. Deline each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Neurosurgery, Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.HarrisburgUSA

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