Demographics: Headache is a common complaint of individuals seeking care in both emergency and outpatient environments. It is estimated that 1 out of 6 Americans have self-reported having a severe headache during the past 3 months, which is a statistic that has remained stable for nearly 20 years1. Headaches in general account for over a quarter of outpatient neurologist appointments but are still often under diagnosed or consequentially under treated. Once considered rare, headaches due to spontaneous intracranial hypotension (SIH) are now being diagnosed more frequently in the radiology department. SIH is mainly caused by a leaking of cerebral spinal fluid (CSF) from the thecal sac along the spinal canal3. When assessing patients for SIH, clinicians have a dual challenge of first, recognizing that a patient may be having intracranial hypotension and secondly identifying the cause and location of the leak. Prevalence Spinal fluid leaks can be caused by several factors such as lumbar punctures,spinal surgery, or injury. Iatrogenic leaks are a result of medical procedures such as lumbar punctures or spinal surgery but a spontaneous leak, in contrast, can happen unknowingly, sometimes because of a minor injury or a history of high intracranial pressure. These leaks can also be congenital and attributed to weak areas of the dura, hormonal factors, and even erosion from small bone spurs on the spine or fistulas directly connected to the dura mater4. Headaches caused by intracranial hypotension have recently been diagnosed in 5 out of every 100,000 patients. This incidence is about half of the frequency of subarachnoid hemorrhage although SIH is thought to be under diagnosed and much more prevalent than once thought.
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