Neurology

Low-Pressure Headache Program

Low-pressure headache is a rare headache syndrome that requires a multidisciplinary team of experts to make the diagnosis, determine the cause, and deliver state-of-the art treatment. Mount Sinai’s physicians are specially trained to provide the highest level of care for patients living with low-pressure headache.

What Is Low-Pressure Headache?
Low-pressure headache, or intracranial hypotension, refers to a rare headache syndrome where the pressure of the cerebrospinal fluid, or CSF, which bathes the brain and spinal cord, is lower than normal. The pressure becomes low most often as a result of a tear in the dura, or the lining outside the brain and spinal cord, through which the CSF leaks. This may be due to trauma, where an injury may have created a tear in the dura. A CSF leak can also occur after a lumbar puncture, or spinal tap, is performed, or after surgery or spinal anesthesia, as in an epidural. Rarely, a CSF leak can also be due to a spontaneous tear in the dura, and this can be found in patients who have connective tissue disorders as their dura is thinner, and therefore more easily stretched and torn.  In many cases, it occurs without a known cause.

What Are the Symptoms of a Low-Pressure Headache, or SIH (spontaneous intracranial hypotension)?
Headache is the most common symptom of SIH. The typical SIH headache is worse when one is standing or sitting, and significantly improves or resolves completely when lying flat. This is called a “postural headache” or “orthostatic headache.”

The headache may also be mild in the morning upon awakening, but progressively worse over the course of the day when one is upright for long periods of time. Often, over time, the head pain is no longer positional. The pain is often severe, and it can be described as throbbing, aching, sharp, stabbing or pressure-like. The headache is commonly at the back of the head, but can also be located in the front, one side at the temple, or may involve the entire head. Many patients experience severe neck pain and sometimes stiffness. Patients may also describe feeling sensitive to light and sound, as is seen with migraine, and may feel nauseated and vomit. Rare symptoms include double vision, difficulty swallowing, hearing loss, vertigo, and loss of consciousness.

How Is Low-Pressure Headache Diagnosed?
If you think you may have a CSF leak or a low-pressure headache, it is important that you be evaluated. The headache specialists at Mount Sinai will obtain a detailed medical history and perform a thorough physical and neurologic examination. Basic lab tests and other imaging studies may be done to rule out other conditions and further evaluate the possible presence and location of a cerebrospinal fluid leak. Finding the cause is crucial to treatment.

How Is Low-Pressure Headache Treated?
Medical management of a low-pressure headache often includes adequate hydration, caffeine, rest, and sometimes anti-inflammatory medications as needed. This is most often used if a patient develops a low-pressure headache after a lumbar puncture.  If required, Mount Sinai’s multidisciplinary team of specialists may perform other procedures to block the fluid leakage.

Meet Our Team

Low-Pressure Neurologist
Rachel Colman, MD
Director, Low-Pressure Headache Program

Supporting Low-Pressure Headache Team
At Mount Sinai, Dr. Colman collaborates with team specialized physicians to manage the care of patients with low-pressure headaches.

Neurologists
Mark W. Green, MD
Anna Pace, MD 
Lauren Natbony, MD

Neuroradiologists
Amit Aggarwal, MD
Amish Doshi, MD

Pain Management Physicians
Yury Khelemsky, MD