High-Pressure Headaches, Low-Pressure Syndromes, and CSF Leaks: Diagnosis and Management


  • Steven B. Graff-Radford DDS,

    Corresponding author
    1. Cedars-Sinai Medical Center, Los Angeles, CA, USA
    • Address all correspondence to S.B. Graff-Radford, The Pain Center, Program for Headache and Orofacial Pain, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Los Angeles, CA 90048, USA.

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  • Wouter I. Schievink MD

    1. Cedars-Sinai Medical Center, Los Angeles, CA, USA
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  • Conflict of Interest: None.



Headache resulting from idiopathic intracranial hypertension (IIH) in a population of moderately to obese women of childbearing age. The causes overall remain unclear. With this review, we provide an overview of clinical treatment and management strategies.


IIH management is dependent on the signs and symptoms presented. Symptomatic treatment should attempt to lower intracranial pressure, reduce pain, and protect the optic nerves. Consideration for lumbar puncture and draining fluid as an option for reducing pressure may be helpful; however, repeated treatment is not usually favored by patients. Traditional prophylactic medications used in migraine may help reduce the primary headache often induced by raised intracranial pressure. We suggested surgical intervention for patients experiencing visual loss or impending visual loss and not responding to medication therapy.


In this review, we discuss headache associated with IIH and spontaneous intracranial hypotension. Much needs to be learned about treatment options for patients with cerebrospinal fluid leaks including methods to strengthen the dura.