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Headache After Sealing of Cerebrospinal Fluid Leaks in Patients With Spontaneous Intracranial Hypotension
Adrian Scutelnic1, Andreas Lüthi1, Isabelle Dominique Stöckli1
1Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
Insights
Persistent headaches after spontaneous intracranial hypotension (SIH) treatment affect 20% of patients, often due to delayed treatment. Long-term outcomes show improvement, but secondary headaches like medication overuse can occur.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Spontaneous intracranial hypotension (SIH) is a significant cause of headaches.
- Invasive treatment is sometimes required for SIH.
Purpose of the Study:
- Investigate clinical presentation of SIH headaches.
- Identify factors linked to incomplete headache resolution after treatment.
- Assess long-term outcomes in patients with persistent headaches post-SIH treatment.
Main Methods:
- Observational longitudinal study.
- Structured questionnaire used to gather data on primary headache, SIH-headache, and post-treatment headache.
- Persistent headache defined as >15 headache days/month for >3 months.
Main Results:
- 56 patients treated invasively for SIH included.
- 20% (11/56) experienced persistent headaches post-treatment.
- Delayed treatment (>362 days) was associated with persistent headaches.
- Secondary causes included new leaks (18%) and rebound intracranial hypertension (18%).
- Medication overuse reported in 27% of persistent headache cases.
- 5-year follow-up: 36% complete resolution, 36% improvement.
Conclusions:
- One-fifth of patients have persistent headaches despite successful CSF leak sealing.
- Long-term prognosis is generally favorable with improvements observed.
- Consider secondary headaches: medication overuse, rebound hypertension, or new/reopened CSF leaks.
Introduction:
Spontaneous intracranial hypotension (SIH) is an important cause of headache that might require invasive treatment. The aim of this study was to systematically investigate (1) clinical presentation, (2) factors associated with incomplete headache resolution, and (3) the long-term outcomes in patients with persistent headache after invasive treatment for SIH.
Methods:
This is an observational longitudinal study. We used a structured questionnaire to assess details on primary headache, SIH-headache, and headache after treatment. Persistent headache was defined as headache on more than 15 days per month lasting longer than 3 months.
Results:
Fifty-six patients invasively treated for SIH were included in the study. The mean age was 49 ± 12 years, and 60% were women. After sealing of the leak, 11/56 (20%) had persistent headache. Compared to subjects without persistent headache, patients with persistent headache had been treated after a longer delay from SIH symptom onset (362 days [IQR 138-714] vs. 111 [68-365]). In 2/11 (18%) patients, a second leak at another level and rebound intracranial hypertension were found, respectively. Medication overuse was reported by 3/11 (27%) patients. After a median follow-up of 5 years, headache subsided completely in 4/11 (36%) patients and improved in 4/11 (36%).
Conclusion:
In our cohort, one fifth of patients suffered from persistent headache despite successful sealing of the CSF leak. Although the majority of patients showed improvement in the long run, important secondary headaches should be considered, namely medication overuse, rebound hypertension, and a persistent, reopened, de novo or second leak at another level.
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