Orthostatic headache caused by low cerebrospinal fluid (CSF) pressure (either spontaneous or secondary), or CSF leakage, usually accompanied by neck pain, tinnitus, changes in hearing, photophophia and/or nausea. It remits after normalization of CSF pressure or successful sealing of the CSF leak.
- Any headache1 fulfilling criterion C
- Either or both of the following:
- low cerebrospinal fluid (CSF) pressure (<60 mm CSF)
- evidence of CSF leakage on imaging2
- Headache has developed in temporal relation to the low CSF pressure or CSF leakage, or led to its discovery3
- Not better accounted for by another ICHD-3 diagnosis.
- 7.2 Headache attributed to low cerebrospinal fluid pressure is usually but not invariably orthostatic. Headache that significantly worsens soon after sitting upright or standing and/or improves after lying horizontally is likely to be caused by low CSF pressure, but this cannot be relied upon as a diagnostic criterion.
- Brain imaging showing brain sagging or pachymeningeal enhancement, or spine imaging (spine MRI, or MRI, CT or digital subtraction myelography) showing extradural CSF.
- Evidence of causation may depend upon onset in temporal relation to the presumed cause, together with exclusion of other diagnoses.