Headache & Facial Pain Specialist, Singapore
​LOW PRESSURE HEADACHES

Topics:
1) What are Low Pressure Headaches?
2) What are the symptoms of a low pressure headache?
3) When do I need to seek treatment for headaches?
4) What are the investigations required to diagnose low pressure headaches?
5) What is the treatment of low pressure headaches?

What are Low Pressure Headaches?
When the term "low pressure headaches" is used, it refers to headaches caused by low pressures in the brain (intracranial hypotension). The brain and spinal cord together form the central nervous system, which is surrounded by cerebrospinal fluid (CSF) and contained within a protective membrane called the dura. The role of the CSF is to provide protection, nourishment, and waste removal for the brain and spinal cord.

These headaches are typically caused by a disruption in the integrity of the dura. Such disruptions result in CSF leakage, causing the brain to sag when a patient is upright, resulting in tension on the meninges and surrounding nerves. This manifests as postural headaches - headaches worsened (or occurring only) with sitting up or standing. However, in patients who have had this condition for a long time, these headaches may become non-posture related. 

What are the symptoms of a Low Pressure Headache?

• Headache that is
  • severe when upright
  • Headache that is mild or disappears when lying flat
  • Headaches that are absent in the morning and worsens throughout the day
• Associated with:
  • Neck discomfort
  • Nausea
  • Blocked ears
  • Associated symptoms improved with restoration of CSF pressure.

When do I need to seek treatment for headaches?
It is advisable to see help if your headaches are:

• Frequent eg. once a week
• Impacts your daily activities / efficiency
• Occur after the age of 50 years old
• Change in the quality of your headaches - eg. intensity, frequency, quality
  
  

Headaches may also serve as an indication of more severe underlying conditions, such as brain tumors, infections affecting the central nervous system, or heightened pressure or bleeding within the brain. It is imperative to seek immediate attention from the emergency department

• Fever and shivering
• Difficulty speaking or swallowing
• Sudden onset of severe pain, often referred to as a 'thunderclap headache'
• Headache intensity varies with changes in position, for instance, worsening upon sitting up after lying down
• Blurred vision or a pulsing ringing sensation in the ears

What are the investigations required to diagnose low pressure headaches?
If required, these are some of the investigations that may be requested by your doctor:

• MRI Scans - eg. Brain / Spine
• CT Myelography
• Lumbar Puncture
• Digital Subtraction Angiography

What is the treatment of low pressure headaches?
The treatment of low pressure headaches depends on the cause. You may be prescribed some medications that will help relief some of the headache. It is also important to use lots of fluids to replenish the CSF that has been lost through leakage. Bed rest can also help to minimize the pain.

If you have persistent symptoms despite these conservative treatment, you may need to speak to a doctor to enquire about the need for an epidural blood patch. This is a minimally invasive procedure in which your own blood is placed outside dura. The clot formed from the blood patch causes temporary sealing of the hole in the dura, raises the brain pressures and also promotes long-term healing of the dura. 

In some rare cases, surgery may be required. However, these are exceptions, rather than the norm.