Update on 'Treatment of orthostatic headache without intracranial hypotension: A case report' - nine years later

xlomafota13 shared this article with you from Inoreader Update on "Treatment of orthostatic headache without intracranial hypotension: A case report" - nine years later Via leak of cerebrospinal fluid Cephalalgia. 2021 Aug 18:3331024211038656. doi: 10.1177/03331024211038656. Online ahead of print. ABSTRACT BACKGROUND: In 2013, one of the authors described a 36-year-old female with orthostatic headache without documented intracranial hypotension or evidence of cerebrospinal fluid leak, despite extensive workup. Headache was unresponsive to conservative treatment since 2010, showed only transient benefit after repeated epidural blood patches while vitamin A supplementation resulted in progressive improvement. CASE: Since 2013, the patient followed a relapsing and remitting course yet relapse control became difficult after a drug induced liver injury required vitamin A discontinuation in 2017, when her headache became chronic. Greater occipital nerve blocks provided pain relief as alternative but were stopped due to the pandemic and her latest severe relapse, in late 2020, required not only restarting anaesthetic blocks and aggressive m edication management, but also reassessing and treating comorbidities (obstructive sleep apnoea and major depressive disorder) with modest benefit. CONCLUSION: Orthostatic headache without intracranial hypotension is rare, with only 28 cases reported so far, all treated empirically and all treatment options revealing to be mostly ineffective. Vitamin A anecdotally appeared to be useful in our case but had to be stopped for severe side effects, so unfavourable long-term prognosis, in ours and 2/3 of the reported cases, seems to be the rule in this intriguing entity. PMID:34404249 | DOI:10.1177/03331024211038656 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.