Diagnostic Criteria for Headache Due to Spontaneous Intracranial Hypotension: A Perspective

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Abstract:

The clinical and radiographic manifestations of spontaneous intracranial hypotension are highly variable and many patients do not satisfy the 2004 International Classification of Headache Disorders criteria. We developed new diagnostic criteria for spontaneous intracranial hypotension based on cases we have seen reflecting the variable manifestations of the disorder. These criteria provide a basis for change when the classification criteria are next revised.

The diagnostic criteria consist of A, orthostatic headache; B, the presence of at least one of the following: low opening pressure (≤60 mm H2O), sustained improvement of symptoms after epidural blood patching, demonstration of an active spinal cerebrospinal fluid leak, cranial magnetic resonance imaging changes of intracranial hypotension (eg, brain sagging or pachymeningeal enhancement); C, no recent history of dural puncture; and D, not attributable to another disorder.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1526-4610.2011.01911.x

Affiliations: 1: From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby). 2: From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby). 3: From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).

Publication date: October 1, 2011

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