Is your migraine not responding to medication? You could have this condition

For patients suffering with chronic migraines, finding relief can be a headache in itself. When trying medication after medication hasn’t worked, it may be time to test for spontaneous intracranial hypotension (SIH).

The condition

SIH is a condition caused by a cerebrospinal fluid leak. The leak may result from a tear in the dura mater – a thick membrane that protects the cerebrospinal fluid around our brain and spinal cord. Most commonly, SIH causes migraine-like headaches, neck pain, nausea, blurred vision, brain fog, and sensitivity to light and sound.

“Patients experiencing low-pressure headaches will feel better when lying down and worse when sitting upright,” explains Dr. Ashley Holdridge, a neurologist at Aurora Health Care. “However, the longer a patient suffers from this condition, the less positional the headache may become.”

So how does the condition come about? To start, it’s rare. SIH affects an estimated 5 per 100,000 people each year, or 0.005%. Despite what the name implies, it’s not always spontaneous. It can be the result of a traumatic event, like a car crash. Patients have also been diagnosed with SIH after riding a roller coaster, doing yoga or having a spinal tap.

Diagnosis and treatment  

A contrasted brain MRI may help doctors determine where the cerebrospinal fluid leak is happening, but according to Dr. Holdridge, it’s not always the answer. Nearly 30% of patients with SIH receive normal MRI test results.

If the MRI shows a clear picture of where the leak is occurring, an epidural blood patch can be performed. This outpatient procedure is when a small volume of blood is injected into the space right before the dura mater. According to Dr. Holdridge, the idea is to plug up the hole and stop the leak.

If the MRI does not show evidence of SIH, but the condition is suspected, doctors can perform a blind blood patch. The procedure also injects blood into the space before the dura mater but targets a more generalized area.

When the condition is identified early on, other treatment options include bed rest and consuming caffeine. In time, the body may also heal itself. Still, if symptoms don’t go away, Dr. Holdridge suggests scheduling a visit to the neurologist.

“If you’re suffering, I encourage you to be optimistic,” says Dr. Holdridge. “While diagnosing spontaneous intracranial hypotension is difficult, finding an accurate diagnosis can lead to significant pain relief.”

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