Headache in spontaneous intracranial hypotension: an overview with indications for differential diagnosis in the clinica
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HEADACHES IN CSF DYNAMICS DISORDERS
Headache in spontaneous intracranial hypotension: an overview with indications for differential diagnosis in the clinical practice Domenico D’Amico 1 & Susanna Usai 1 & Luisa Chiapparini 2 & Alessandra Erbetta 2 & Andrea Gioppo 3 & Giuseppe Messina 4 & Alberto Astengo 1 & Massimo Leone 1
# Fondazione Società Italiana di Neurologia 2020
Abstract Headache is the most common symptom of spontaneous intracranial hypotension (SIH). The present review focuses on data regarding headache features reported in the most relevant published articles and summarizes the main SIH headache features, namely, orthostatic headache, headache triggered by Valsalva maneuver, pattern of onset of headache, and location and quality of headache. Published data indicate that the clinical suspect of this disorder may be challenging, due to its protean presentation. Among the main implications for clinical practice, we suggest to suspect SIH in all patients with a new onset headache, as different forms of primary and secondary headache should be considered in the differential diagnosis of SIH, particularly cervicogenic headache, new daily persistent headache, and headaches precipitated by Valsalva maneuver. The clinical interview must include specific questions on the possible orthostatic feature of headache, although its absence should not make clinicians to reject the SIH hypothesis as headache cannot be orthostatic in each patient and in all periods of the natural history of the disease. Other disorders with orthostatic symptoms, such as in postural tachycardia syndrome (POTS) and persistent postural-perceptual dizziness (PPPD), should be considered in the differential diagnosis. Awareness that SIH can present with acute, sudden onset requires that clinicians working in the emergency settings should consider SIH in the range of diagnoses of thunderclap headache. Keywords Headache . Spontaneous intracranial hypotension (SIH) . Orthostatic symptoms . Thunderclap headache . Differential diagnosis
Abbreviations SIH Spontaneous intracranial hypotension NDPH New daily persistent headache ICHD International classification of headache disorders PPPD Persistent postural-perceptual dizziness POTS Postural orthostatic tachycardia syndrome
* Domenico D’Amico [email protected] 1
Neuroalgology Unit, Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
2
Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
3
Radiodiagnostic and Interventional Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
4
Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
Introduction Headache is the most common symptom in patients with spontaneous intracranial hypotension (SIH), and it is positional, namely, orthostatic in the vast majority of the cases [1, 2]. As for all the secondary headaches, suspect diagnosis of headache attributed to SIH relies mainly on clinical presentation and m
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