Disparities in Access to Specialized Care for Spontaneous Intracranial Hypotension: A Comparative Cohort Study

Patients with spontaneous intracranial hypotension (SIH) often face substantial delays in diagnosis and treatment. Barriers to accessing specialized care for SIH remain poorly understood, particularly regarding potential demographic and/or socioeconomic disparities. Our aim was to evaluate whether patients seen in a specialized CSF leak clinic differ demographically or socioeconomically from those presenting to the emergency department (ED) with headache who undergo neuroimaging.

We retrospectively compared all patients evaluated in the University of Colorado CSF Leak Program in March 2025 with patients presenting to the ED at our institution during the same month with a primary symptom of headache who underwent neuroimaging. Demographic and socioeconomic variables were extracted from the electronic medical record and compared between groups using the χ² test, t tests, or the Mann-Whitney U test, as appropriate.

A total of 95 patients from the CSF leak clinic and 130 patients from the ED headache clinic were included in this study. Patients seen in the CSF leak clinic were significantly more likely to be women (76.8% versus 57.7%, χ² = 8.9, P = .003), White (89.5% versus 47.7%, χ² = 45.5, P < .001), have private insurance (72.6% versus 41.5%, χ² = 27.91, P < .001), and report English as their primary language (96.8% versus 75.4%, χ² = 21.3, P < .001). The median driving distance to the hospital was substantially longer in the CSF clinic cohort (23 miles; interquartile range, 12-70 versus 7 miles; interquartile range, 6-12 miles; Mann-Whitney U test = 9562, P < .001). ZIP code-based household income did not differ significantly between groups ($98,000 versus $91,000; t = 1.20, P = .11).

Patients accessing specialized care for SIH at a tertiary referral center are more likely to be White, English-speaking, and privately insured compared with patients presenting to the ED with headache, despite coming from greater geographic distances. These findings suggest significant disparities in access to specialty care for SIH, highlighting the need for targeted outreach, streamlined referral pathways, and broader diagnostic awareness in general practice and emergency settings.