Headache After Sealing of Cerebrospinal Fluid Leaks in Patients With Spontaneous Intracranial Hypotension.

Introduction
Spontaneous intracranial hypotension (SIH) is an important cause of headache that might require invasive treatment. The aim of this study was to systematically investigate (1) clinical presentation, (2) factors associated with incomplete headache resolution, and (3) the long-term outcomes in patients with persistent headache after invasive treatment for SIH.Methods
This is an observational longitudinal study. We used a structured questionnaire to assess details on primary headache, SIH-headache, and headache after treatment. Persistent headache was defined as headache on more than 15 days per month lasting longer than 3 months.Results
Fifty-six patients invasively treated for SIH were included in the study. The mean age was 49 ± 12 years, and 60% were women. After sealing of the leak, 11/56 (20%) had persistent headache. Compared to subjects without persistent headache, patients with persistent headache had been treated after a longer delay from SIH symptom onset (362 days [IQR 138-714] vs. 111 [68-365]). In 2/11 (18%) patients, a second leak at another level and rebound intracranial hypertension were found, respectively. Medication overuse was reported by 3/11 (27%) patients. After a median follow-up of 5 years, headache subsided completely in 4/11 (36%) patients and improved in 4/11 (36%).Conclusion
In our cohort, one fifth of patients suffered from persistent headache despite successful sealing of the CSF leak. Although the majority of patients showed improvement in the long run, important secondary headaches should be considered, namely medication overuse, rebound hypertension, and a persistent, reopened, de novo or second leak at another level.