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Observational Study
. 2025 Aug;32(8):e70237.
doi: 10.1111/ene.70237.

Headache After Sealing of Cerebrospinal Fluid Leaks in Patients With Spontaneous Intracranial Hypotension

Adrian Scutelnic  1 , Andreas Lüthi  1 , Isabelle Dominique Stöckli  1 , Lucie Justus  1 , Bettina Bracher  1 , Antonia Klein  1 , Nedelina Slavova  1 , Eric Morel  1 , Franz Riederer  1 , Tomas Dobrocky  2 , Eike I Piechowiak  2 , C Marvin Jesse  1 , Christian T Ulrich  3 , Jürgen Beck  4 , Ralph T Schär  3 , Christoph J Schankin  1   5
Affiliations
Observational Study

Headache After Sealing of Cerebrospinal Fluid Leaks in Patients With Spontaneous Intracranial Hypotension

Adrian Scutelnic et al. Eur J Neurol. 2025 Aug.

Abstract

Introduction: Spontaneous intracranial hypotension (SIH) is an important cause of headache that might require invasive treatment. The aim of this study was to systematically investigate (1) clinical presentation, (2) factors associated with incomplete headache resolution, and (3) the long-term outcomes in patients with persistent headache after invasive treatment for SIH.

Methods: This is an observational longitudinal study. We used a structured questionnaire to assess details on primary headache, SIH-headache, and headache after treatment. Persistent headache was defined as headache on more than 15 days per month lasting longer than 3 months.

Results: Fifty-six patients invasively treated for SIH were included in the study. The mean age was 49 ± 12 years, and 60% were women. After sealing of the leak, 11/56 (20%) had persistent headache. Compared to subjects without persistent headache, patients with persistent headache had been treated after a longer delay from SIH symptom onset (362 days [IQR 138-714] vs. 111 [68-365]). In 2/11 (18%) patients, a second leak at another level and rebound intracranial hypertension were found, respectively. Medication overuse was reported by 3/11 (27%) patients. After a median follow-up of 5 years, headache subsided completely in 4/11 (36%) patients and improved in 4/11 (36%).

Conclusion: In our cohort, one fifth of patients suffered from persistent headache despite successful sealing of the CSF leak. Although the majority of patients showed improvement in the long run, important secondary headaches should be considered, namely medication overuse, rebound hypertension, and a persistent, reopened, de novo or second leak at another level.

Keywords: CSF leak; CSF‐venous fistula; SIH; medication overuse headache; myelography; persistent headache; secondary headache; surgical sealing of CSF leak.

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Conflict of interest statement

A.S. reports research grants from the Swiss Heart Foundation and TEVA. C.J.S. reports fees for consulting, advisory boards, speaker activities, and travel support for/from Abbvie, Almirall, Amgen, Eli Lilly, Lundbeck, Novartis, Pfizer, TEVA Pharmaceuticals, MindMed, Grünenthal; he is part‐time employee at Zynnon and Cefalognos; he received research grants from the German Migraine and Headache Society, Eye on Vision Foundation, Lundbeck, Swiss Heart Foundation, Teva Pharmaceuticals, Visual Snow Syndrome Germany e.V., Visual Snow Initiative, and Baasch Medicus Foundation. All other authors report no relevant conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Sankey diagram showing the proportion of patients with persistent headache over time in a cohort invasively treated for spontaneous intracranial hypotension (SIH).
See this image and copyright information in PMC

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