Abstract
Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our primary effect parameter was total headache burden defined as area under the curve (AUC: intensity × duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency (days per month), duration in hours (total hours/month) and also medication days (days on medication/month). In our primary effect parameter we found a significant reduction in AUC with more than 25% and this is considered to be clinically relevant. We found also a significant and relevant reduction at −22% in intensity. A trend towards reduction in duration was seen. We found no statistically significant reduction in frequency. An increase in days with use of medication was found. Increased awareness of low CSF pressure headache is emphasized and a controlled larger randomized study is needed to confirm the results. However the present results, allows us to conclude that EBP in treatment-refractory low CSF pressure headache can be considered as a treatment option.
Highlights
First described in 1938 low cerebrospinal fluid (CSF) pressure headache is still an under-diagnosed headache disorder
Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, among young and middle-aged individuals
Our primary effect parameter was total headache burden defined as area under the curve (AUC: intensity 9 duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency, duration in hours and medication days
Summary
First described in 1938 low CSF pressure headache is still an under-diagnosed headache disorder. This being partly due to unfamiliarity, and with the overlap with other forms of headache, often leading to misdiagnosis, incorrect treatment and leaving the patient with a persistent severe headache [1]. Low CSF pressure headache has significant symptom-overlap with migraine, tension type headache, post-infectious headache and most commonly post-dural puncture headache [2]. Symptoms vary greatly but the orthostatic headache, tinnitus, hypacusis, photophobia and/or nausea indicating low CSF pressure are the most frequently reported [4]. The associated symptoms may vary ranging from classic neurological symptoms to cognitive defects [3].
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