Abstract

The syndrome of persistent low cerebrospinal fluid (CSF) volume (pressure) headache is an important diagnosis for neurologists and others not to miss, because it is a treatable cause of disabling headache. It forms part of the more general diagnostic rubric of New Daily Persistent Headache (NDPH), the key feature of which is a new headache that develops over one or just a few days, and then persists (Li & Rozen 2002). This presentation should trigger a consideration of the differential diagnosis of NDPH (Table 1), particularly of treatable causes for the syndrome. Low CSF volume (pressure) headache is a very good example of this clinical phenotype.

PATHOPHYSIOLOGY

While the concept of low CSF volume (pressure) headache may seem simple enough on the surface, it has some complexities. The pain is generally considered to be due to traction on pain-producing intracranial structures – large vessels, large venous sinuses and dura mater. Indeed