Intracranial Hypotension - Diagnostic Criteria

These criteria apply to spontaneous intracranial hypotension syndromes, rather than the low pressure headache due to cerebrospinal fluid leak following epidural or lumbar puncture or spinal tap procedures.

There have been several revisions of the Diagnostic Criteria for Low Pressure Headache syndromes.

The criteria now proposed are:

1. Demonstration of spinal CSF leak

(i.e. evidence that CSF has leaked out of its normal location within the thecal sac)

2. Cranial MRI changes of low CSF pressure and ONE of the following
   • Postural headache (also called orthostatic headache)
   • Low opening pressure (<60mm)
   • Spinal Meningeal Diverticulum
   • Improvement of Symptoms after Epidural Blood Patching

If Criteria 1 and 2 are not met:

3. The presence of all of the following, or at least TWO of the following if typical postural headache or orthostatic headache is present:
   • Low opening CSF pressure
   • Spinal Meningeal Diverticulum
   • Improvement of Symptoms after Epidural Blood Patching