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Medic-All Headache Team, Taipei VGH 〉 Manangement of low pressure headache

Manangement of low pressure headache

Manangement of low pressure headache

1. Non-invasive evaluations: Heavily T2-weighted MR myelography
2. Targeted epidural blood patch

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Overview
Low pressure headache is characterized by orthostatic headache that occurs in an upright posture, and results from leakage of cerebrospinal fluid (CSF), which could occur spontaneously (spontaneous intracranial hypotension, SIH) or as a complication of medical procedures (post-dural puncture headache, PDPH). Localization of spinal CSF leakage can be achieved by our heavily T2-weighted magnetic resonance myelography (HT2W MRM), which is a non-invasive radiation-free imaging technique, and epidural blood patching (EBP) is delivered at the identified spinal CSF leaks by an expert.
Features
Since 1998, more than 300 patients with low pressure headache  had been managed in our institute with a high success rate. The vast majority of them were successfully treated with targeted EBPs, and only one patient (0.3%) underwent surgical repair after failing multiple EBPs. The complication is very low. Only one patient died due to complicated subdural hematoma.
Service Procedure
Patients with suspected SIH will undergo brain MRI with contrast and whole-spine HT2W MRM to establish the diagnosis and to localize the spinal CSF leak.
EBPs are delivered at the level of identified spinal CSF leaks by an experienced anesthesiologist, which is followed by complete bed rest for 6-12 hours.
If there are residual symptoms, the process is repeated until resolution of symptoms. In the presence of intracranial subdural hematoma (SDH), surgical evaculation is carried out for those with SDH ≥10mm or with a decreased level of consciousness (GCS<15).
Notification
EBPs are generally well tolerated, although tightness or paresthesia along radicular distributions or regional pain at the level of EBP is not uncommon, which usually subside in several days.
Rebound increase in intracranial pressure, manifested as paradoxical headache in the supine position, is occasionally seen, and usually resolves in one day.
Estimated Cost
(Prices listed below are for reference. Actual cost may be according to the real expense during the hospitalization.)
2000-5000 USD
 
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