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KMID : 0911820140150010008
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Korean Journal of Headache
2014 Volume.15 No. 1 p.8 ~ p.12
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Therapeutic Strategies in Patients with Spontaneous Intracranial Hypotension or Post-dural Puncture Headache
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Lee Ju-Youn
Kim Seong-Bo
Oh Ji-Eun
Kim Jae-Moon
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Abstract
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Background: Spontaneous intracranial hypotension (SIH) and post-dural puncture headache (PDPH) are common causes
of orthostatic headache. Treatment of these headache ranges from conservative management to invasive procedures
such as epidural blood patch (EBP), fibrin glue injection and open surgical intervention. Conservative management like
prolonged bed rest is difficult to maintain. So we analyzed results of treatment of patients with SIH or PDPH.
Methods: We reviewed medical records of 76 admitted patients with orthostatic headache from January 2010 to April
2013, retrospectively. At first, patients had conservative management. If their symptoms did not resolve spontaneously
with hydration and bed rest, treatment with EBP was done in all patients. We analyzed symptoms improvement
according to how to management and what causes the disease.
Results: Thirty three patients were diagnosed as SIH, and 39 patients were PDPH according to ICHD-2. Twenty eight
patients (85%) with SIH received single or repeated EBPs. Twenty out of 21 patients (95%) with SIH whose myelogram
showed CSF leakage did not improve by ABR and required EBP. Eighty two percent of PDPH caused by lumbar
puncture was improved by conservative management, spontaneously. However, PDPH caused by discectomy is needed
repeated EBPs.
Conclusion: Orthostatic headache should consider the therapeutic strategy by its cause or whether presenting evidence
of active leakage. SIH patients who have evidence of leakage in MR myelogram should get early EBP. Initial treatment
of PDPH caused by lumbar puncture should be treated by conservative management of bed rest.
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KEYWORD
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Headache, Intracranial hypotension, Post-dural puncture headache, Epidural blood patch
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