Efficacy of epidural blood patches for spontaneous low-pressure headaches: a case series

Patients with a spontaneous cerebrospinal fluid leak, normally at a spinal level, typically present with low-pressure headache. In refractory cases, an epidural blood patch may be attempted. We aimed to assess the efficacy of lumbar epidural blood patching in spontaneous, low-pressure headaches. Methods We retrospectively analysed notes of patients who had an epidural blood patch performed for spontaneous low-pressure headaches in a single centre. Information regarding demographics, radiology and clinic follow-up was extracted from an electronic patient record system. Questionnaires regarding outcome were sent to patients a minimum of 6 months post-procedure. All patients received an epidural blood patch in the lumbar region irrespective of the site of cerebrospinal fluid leak. Results Sixteen patients who underwent lumbar epidural blood patching were analysed (11 female; mean age 43 years). The site of cerebrospinal fluid leak was evident in only 3/16 patients. Thirteen patients attended clinic follow-up; three reported complete headache resolution, four reported improvement in intensity or frequency and six described no change. Five of eight questionnaire respondents reported reduction in pain, and in these responders, mean headache severity improved from 9/10 to 3/10. Five of eight patients returning follow-up questionnaires reported sustained improvement in headache symptoms. Conclusion Epidural blood patch procedures can provide sustained improvement in headache symptoms in selected patients with spontaneous intracranial hypotension, but an untargeted approach has a lower success rate than reported in other case series.