Spontaneous Intracranial Hypotension

10 Myths and Misperceptions

Peter G. Kranz, MD; Linda Gray, MD; Timothy J. Amrhein, MD


Headache. 2018;58(7):948-959. 

In This Article


Spontaneous intracranial hypotension (SIH) is an important cause of secondary headaches resulting from spinal cerebrospinal fluid (CSF) leaks that has received increasing attention over the past few decades. Although historically perceived as rare, SIH is now being recognized more commonly; the incidence of SIH has been estimated at 5 per 100,000. For comparison, aneurysmal subarachnoid hemorrhage, which is not generally perceived as a rare medical condition, occurs at a rate of 10 per 100,000.[1] The true incidence of SIH is expected to be higher, as it is frequently misdiagnosed initially.[2]

Although awareness of this condition is increasing, exposure of providers to SIH remains infrequent in most practices, meaning that levels of practical experience in diagnosis and management are generally low. At the same time, a more complex understanding of the underlying pathophysiology of the condition has emerged in recent years, fed by numerous avenues of accelerating scientific investigation.[3] As a consequence, conceptions about appropriate diagnosis and treatment of SIH are sometimes based on outdated or insufficient information.

The purpose of this narrative review is to present common myths and misperceptions about SIH that we encounter frequently in our practice at a large referral center. The review will also discuss the evidence that contradicts these misperceptions, and will provide an up-to-date summary of current knowledge about this condition.