Current perspectives on the recognition and diagnosis of low CSF pressure headache syndromes

Introduction Headaches occur when cerebrospinal fluid (CSF) pressure drops following dural puncture or trauma or spontaneously. As the features of these headaches and their accompanying symptoms might not be typical, low CSF pressure headache syndromes, and spontaneous intracranial hypotension in particular, are often misdiagnosed and underdiagnosed. Areas covered The aim of this narrative review is to summarize the most recent evidence regarding the clinical presentation and the diagnosis of low CSF pressure headache syndromes. Expert opinion The clinical spectrum low CSF pressure headache syndromes varies significantly and key signs might be missing. Low CSF pressure headache syndromes should be included in the differential diagnosis of any case of refractory headache, even when the headache is not orthostatic, or there are normal neuroimaging findings, and/or lumbar puncture opening pressure is within normal limits. Future research should focus on controlled interventional studies on the treatment of low CSF pressure headache syndromes, which are currently lacking.

Automated summary

Low cerebrospinal fluid (CSF) pressure headache syndromes, especially spontaneous intracranial hypotension, are often misdiagnosed and underdiagnosed due to atypical features. This review aims to summarize the latest evidence on the clinical presentation and diagnosis of these syndromes. Key signs of low CSF pressure headache syndromes may be missing and should be considered in the differential diagnosis of refractory headaches, even with normal neuroimaging findings and lumbar puncture opening pressure within normal limits. Future research should focus on controlled interventional studies for the treatment of low CSF pressure headache syndromes, which are currently lacking.