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Diagnostic Criteria for Headache Due to Spontaneous Intracranial Hypotension: A Perspective

Authors

  • Wouter I. Schievink MD,

    Corresponding author
    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
      W.I. Schievink, Cedars-Sinai Medical Center – Maxine Dunitz Neurosurgical Institute, 8631 West Third Street, Suite 800 E, Los Angeles, CA 90048, USA. Email: schievinkw@cshs.org
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  • David W. Dodick MD,

    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Bahram Mokri MD,

    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Stephen Silberstein MD,

    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Marie-Germaine Bousser MD,

    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Peter J. Goadsby MD, PhD

    1. From the Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA (W.I. Schievink); Department of Neurology, Mayo Clinic, Phoenix, AZ, USA (D.W. Dodick); Department of Neurology, Mayo Clinic, Rochester, MN, USA (B. Mokri); Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA (S. Silberstein); Department of Neurology, Hospital Lariboisiere, Paris, France (M.-G. Bousser); UCSF Headache Group – Department of Neurology, University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Conflict of Interest: None

W.I. Schievink, Cedars-Sinai Medical Center – Maxine Dunitz Neurosurgical Institute, 8631 West Third Street, Suite 800 E, Los Angeles, CA 90048, USA. Email: schievinkw@cshs.org

Abstract

The clinical and radiographic manifestations of spontaneous intracranial hypotension are highly variable and many patients do not satisfy the 2004 International Classification of Headache Disorders criteria. We developed new diagnostic criteria for spontaneous intracranial hypotension based on cases we have seen reflecting the variable manifestations of the disorder. These criteria provide a basis for change when the classification criteria are next revised.

The diagnostic criteria consist of A, orthostatic headache; B, the presence of at least one of the following: low opening pressure (≤60 mm H2O), sustained improvement of symptoms after epidural blood patching, demonstration of an active spinal cerebrospinal fluid leak, cranial magnetic resonance imaging changes of intracranial hypotension (eg, brain sagging or pachymeningeal enhancement); C, no recent history of dural puncture; and D, not attributable to another disorder.

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