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Headache associated with intracranial hypotension: diagnostic challenges and difficulties in everyday neurological practice
Affiliations- Health Institute Dr. Boczarska-Jedynak, Oswiecim, Poland
open access
Abstract
Low pressure of cerebrospinal fluid (CSF) is a rare cause of headache, except when the patient undergoes a lumbar puncture. Headache associated with a low CSF pressure i.e. intracranial hypotension causes diagnostic difficulties. Headaches related to spontaneous intracranial hypotension (SIH) pose a significant diagnostic challenge in everyday neurological practice. Patients with headaches due to SIH are usually diagnosed only after a long delay. Diagnostic problems may result in unnecessary invasive diagnostic procedures, or even neurosurgical operations. Diagnosing headaches attributed to SIH requires the consideration of several clinical scenarios, and the disease’s features causing primary or secondary disturbances. In this review, we discuss the differential diagnosis of SIH-related headaches with reference to accumulated knowledge, including meta-analyses, guidelines, casuistry, and the applicable criteria of the International Classification of Headache Disorders. In addition, we discuss head and spine magnetic resonance imaging abnormalities, which may indicate intracranial hypotension.
Abstract
Low pressure of cerebrospinal fluid (CSF) is a rare cause of headache, except when the patient undergoes a lumbar puncture. Headache associated with a low CSF pressure i.e. intracranial hypotension causes diagnostic difficulties. Headaches related to spontaneous intracranial hypotension (SIH) pose a significant diagnostic challenge in everyday neurological practice. Patients with headaches due to SIH are usually diagnosed only after a long delay. Diagnostic problems may result in unnecessary invasive diagnostic procedures, or even neurosurgical operations. Diagnosing headaches attributed to SIH requires the consideration of several clinical scenarios, and the disease’s features causing primary or secondary disturbances. In this review, we discuss the differential diagnosis of SIH-related headaches with reference to accumulated knowledge, including meta-analyses, guidelines, casuistry, and the applicable criteria of the International Classification of Headache Disorders. In addition, we discuss head and spine magnetic resonance imaging abnormalities, which may indicate intracranial hypotension.
Keywords
intracranial hypotension, spontaneous intracranial hypotension, orthostatic headache
About this articleTitle
Headache associated with intracranial hypotension: diagnostic challenges and difficulties in everyday neurological practice
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Invited Review Article
Pages
21-30
Published online
2024-02-23
Page views
380
Article views/downloads
275
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2024;58(1):21-30.
Keywords
intracranial hypotension
spontaneous intracranial hypotension
orthostatic headache
Authors
Magdalena Boczarska-Jedynak
Daniel Stompel
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