OVERVIEW
Overview of low cranial pressure headache
Low cranial pressure headache refers to the headache caused by the decrease of cerebrospinal fluid pressure (<60㎜H2O), which is mostly postural, often manifested as headache when sitting up or standing, which may be accompanied by nausea and vomiting, and the symptom may be relieved or disappear after lying down.
Whether medical insurance
yes
Department
Neurology, Emergency Medicine
Clinical symptoms
The main manifestation is position-related headache, which is obvious in sitting or standing position and may be accompanied by nausea, vomiting, diplopia, tinnitus, vertigo, imbalance, neck pain or stiffness, etc. The headache is relieved after lying down.
Harm
Symptoms affect normal life and work. Low cranial pressure may cause damage to cranial nerves such as the motor nerve, facial nerve, vestibulocochlear nerve and glossopharyngeal nerve.
Examination
Physical examination, lumbar puncture to measure cerebrospinal fluid pressure, CT, MRI, PET, etc.
Diagnosis
Low cranial pressure headache is suspected if the headache is characterized by postural headache, and it can be diagnosed by combining CT and MRI examination and excluding other diseases.
Treatment principle
Non-surgical treatment is mainly to improve the symptoms, if there is a cause, the cause should be removed, and those who cannot be treated by internal medicine or whose internal medicine is ineffective should consider surgical treatment.
Curability
Most low cranial pressure headaches are self-limiting and most have a good prognosis.
Dietary advice
A light, low-sugar diet rich in vitamins is recommended. Coffee can be consumed to promote cerebrospinal fluid secretion.
Etiology
Etiology
The primary cause is unknown. Secondary causes include cerebrospinal fluid leakage due to trauma, surgery, lumbar puncture, strenuous exercise, dehydration, severe infections, poisoning, and shock. Head radiotherapy and other treatments can also lead to low cerebrospinal fluid secretion causing low cranial pressure. A small number of patients have normal cerebrospinal fluid pressure.
Symptoms and Diagnosis
Typical symptoms
Pain after lumbar puncture
Most of them appear within 24-48 hours after lumbar puncture, and the headache is mostly bilateral and symmetrical, mostly in the occipital region, frontal region, or the whole head, and may radiate to the neck and shoulder region. Headaches can also be triggered by shaking the head, coughing, sneezing, and exertion. The nature of the pain is dull, distended, or throbbing.
Spontaneous Low Cranial Pressure
It is common in adults around 40 years of age, about 1/3 of patients have a history of trauma. The headache is mostly upright and usually occurs within 15 minutes after standing upright, and in a few cases it may be delayed for several hours. Some patients have headache in the afternoon or evening or after exertion, which is not upright, and may be accompanied by nausea and vomiting, cervical rigidity, blurred vision, diplopia, stuffy feeling in the ears, tinnitus, auditory hypersensitivity, and vertigo imbalance.
Diagnostic basis
Headache symptoms are related to body position, and the development of headache is temporally related to low cerebrospinal fluid pressure or cerebrospinal fluid leakage.
Cerebrospinal fluid pressure below <60㎜ H2O and/or imaging findings of cerebrospinal fluid leakage. Cerebrospinal fluid pressure may be normal in a small percentage of patients.
Except for other diseases.
Treatment
Treatment guidelines
Non-surgical treatment is mainly to improve the symptoms, remove the cause of the disease if there is a cause, and consider surgical treatment if the patient cannot be treated internally or the internal medicine treatment is ineffective.
Drug treatment
Intravenous infusion of large amounts of saline, intravenous glucocorticoids, caffeine and theophylline.
Surgical treatment
Repair of cerebrospinal fluid leak, epidural blood patch therapy.
Other treatments
Decubitus lying, lower limb elevation of 30 degrees, percutaneous injection of hemofibrin sealant, etc.
Prognosis
Most low cranial pressure headaches are self-limiting, and with early diagnosis and timely treatment, most have a favorable prognosis.
Questions you may be concerned about
How are low cranial pressure headaches treated?
The treatment of low cranial pressure headache includes etiologic treatment, drug treatment, epidural blood patch therapy, symptomatic therapy and so on.
1. Etiological treatment: treatment for the causes of lowered cranial pressure, such as cerebrospinal fluid leakage can be considered for fistula repair; diabetic ketoacidosis can be given to insulin hypoglycemia and other treatments.
2. Drug therapy: consider the use of caffeine benzoate and other drugs to promote intracranial vasoconstriction, increase cerebrospinal fluid pressure, relieve headache.
3. Epidural blood patch therapy: mainly used for headache after lumbar puncture and spontaneous low cranial pressure, with autologous blood 10~20ml slowly injected into the lumbar or thoracic epidural space, blood upward filling several vertebral spaces, compression of the dural sac and blockage of cerebrospinal fluid leakage outlets, which can help to relieve the symptoms of headache.
4. Symptomatic treatment: take the decubitus position or the head-low-feet-height position for bed rest; drink a lot of water, and the daily water intake should be about 3500~400ml; intravenous rehydration, saline or 5% dextrose solution can be used; wear tight pants and corsets, and so on.
There are many causes of low cranial pressure headache, it is recommended to seek medical treatment as soon as possible to clarify the cause of the disease and formulate a reasonable treatment plan according to the actual condition.
Nursing care
Daily care
Pay attention to rest and appropriate exercise.
Avoid respiratory tract infection.
Diet
A light, low-sugar diet, vitamin-rich food, avoid spicy and stimulating food, avoid smoking and alcohol.