Each day this week, we’ll be discussing some of the neurological symptoms and complications related to spinal cerebrospinal fluid (CSF) leak.
Up first, by far the most common symptom (though not seen in every patient): Headache.
The loss of CSF volume due to a leak along the spinal axis results in a range of symptoms. Orthostatic headache—head pain upon being upright that resolves when a person is flat—is the most common, and symptoms can be mild to very disabling. Often, a patient may have very limited ability to function while in the upright position.
Common features and patterns of headache due to a spinal CSF leak:
- It is usually positional, occurring within seconds, minutes, or hours of assuming upright posture, and improving within minutes or hours of assuming a recumbent position. Over time, this positional aspect can diminish and even disappear. Very occasionally, this positional aspect can be reversed, with some people feeling improved when upright.
- The location of the head pain is most often occipital (back of head) or suboccipital (lower aspect of back of head, at the base of skull), but may be frontal, temporal or diffuse.
- Severity of the headache varies from mild to severe—and in some cases is completely absent.
- Neck stiffness often accompanies the head pain.
The underlying mechanisms of the pain are a subject of some debate. It is thought that venous distension is involved, as well as possibly traction on pain-sensitive structures related to brain sag. Both more marked with upright posture. A hallmark of this pain is that it is poorly responsive to medications normally used to treat migraine—indeed, this should be a clue that a diagnosis of migraine is incorrect. Treatment targeted to the underlying cause, a spinal CSF leak, can lead to a cure in many cases.