Intracranial hypotension


  • Low pressure headaches caused by spontaneous intracranial hypotension
  • Provoked (e.g. LP) or spontaneous (dural leak)
  • Rare. Max 50yo ♀
  • Risks: Minor trauma, Marfans, neurofibromatosis, polycystic kidney diesase


  • Worse by change in position particularly supine to upright
  • Max minutes after standing, ↓↓with lying down
  • Generalised headache, ± neck ache, N&V, ± tinnitus

Differential Dx


  • MRI with gadolinium = pachymeningeal enhancement & brain “sagging” (see post LP headache)
  • Dx confirmed with LP opening pressure (<6cm water in lat. decubitus) - but .... beware worsening headache


  • Rehydration, simple analgesics
  • Blood patch

Content by Dr Íomhar O' Sullivan . Last review Dr ÍOS 15/06/21.