Low CSF headache

These headaches are caused by an internal Cerebrospinal Fluid leak that can be caused by trauma, spinal tap or surgery.  Symptoms can be subtle, or severe and are most notably diagnosed by a headache that occurs when a patient stands up quickly and then goes away immediately as they lay back down.  The area affected is known as the Meninges that comprise a fluid filled sac that helps to remove waste products form the brain as well as cushion it during head movement or trauma.  

Diagnostic testing

  • MRI with contrast to enhance the Menginges or to visualize the brain sagging, as the sac is no longer supporting brain matter to the same extent
  • CT Myelogram to reveal the site of CSF leakage
  • CSF Cisternogram (radioactive dye with a camera) may reveal a presence of leakage, but not a direct site
  • Lumbar puncture may reveal the presence of low CSF and may temporarily increase symptoms
  • History, positional testing: laying to standing and back to laying can reveal the assurance of a leakage without diagnostic confirmation

Treatment

Treatment is often conservative with these patients, recommending increase in fluid intake, strict bed rest and increased caffeine intake.  If this does not work an epidural patch is often considered, which consists of a portion of the patients own blood and injected into the CSF to "patch" the hole.  It is done at the site of leakage if that is known, or into the lower back if the leakage site is unknown.  There is also the potential of an interventional radiological treatment if the site is known.  They will use radiologically guided needle to glue the hole.  A Neurosurgeon may be necessary if the tear is larger in diameter, or if it is inside the skull.  An otolaryngologist may be used as well, if the tear is within the skull.  Chiropractic Neurology is not utilized in treatment, but may be useful in diagnosing the presenting condition.