Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective

Abstract

Spontaneous low cerebrospinal fluid pressure headaches are a rare but treatable cause of debilitating headaches. The condition is characterized by a postural headache in the absence of any recent spinal procedures and is exacerbated when upright and relieved when supine. Diagnosis and treatment are often delayed, however, due to a lack of recognition and awareness, as illustrated by this case report of a patient who had multiple emergency department visits before further investigations were sought. RÉ SUMÉUne diminution spontané e de la pression du liquide cé phalorachidien est une cause rare mais soignable de cé phalé es dé bilitantes. L'affection se caracté rise par des cé phalé es orthostatiques, en l'absence de toute intervention rachidienne ré cente, qui s'intensifient en position debout et s'atté nuent en position couché e. La pose du diagnostic et la mise en route du traitement sont souvent retardé es en raison d'un manque de reconnaissance de l'affection et de prise de conscience de son existence, comme en té moigne le pré sent exposé de cas d'une patiente qui a consulté à plusieurs reprises au service des urgences avant que ne soit entreprise une exploration approfondie.

Headache in the Emergency Room

“…Intravenous (IV) or oral caffeine and IV fluids are often used, but no randomized controlled studies have been conducted to support their use. 44 An epidural blood patch may be attempted if conservative treatment fails, and if localized CSF leak is identified, corrective surgery may be warranted.…”