The 68th
Scientific Meeting
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| 19S-048 |
Targeted C2 epidural blood patch in spontaneous intracranial hypotension headache overlapped with chronic migraine
Department of anesthesiology and pain medicine,
Samsung medical center, Sungkyunkwan university school of medicine
Introduction
Spontaneous intracranial hypotension headache (SIHH) is caused by low cerebrospinal fluid (CSF) pressure and it can involve symptoms such as nausea, vomiting, tinnitus, vertigo, hypoacusis, neck stiffness or photophobia. We report a case of targeted cervical EBP on direct leakage site for the treatment of SIHH overlapped with chronic migraine.
Case
A 37-year-old woman was referred to our pain with a worsening orthostatic headache from a month ago (7/10 on a numerical rating scale, NRS; 0=no pain, 10=worst pain imaginable). She had been suffering from chronic migraine. The postural headache suddenly occurred 18 months ago immediately after she had tried to remove a heavy object. At that time, she was in the early pregnancy, and the neurologist had thought that her migraine was exacerbated by pregnancy. She had received ultrasound-guided greater occipital nerve pulsed radiofrequency (PRF) in the 24th and 28th week of her pregnancy. However, after delivery, her postural headache became worse. To exclude SIHH, computed tomography myelography was done. It revealed a CSF leakage at dura-sleeve of right C2 nerve. We performed EBP at the C6/7 level with 7 cc of autologous blood, but the symptoms did not improve. Therefore, we decided a targeted EBP at the leakage site. The epidural catheter tip was positioned up to C2 level, and 5 cc of autologous blood was injected. There was a mild improvement in the symptom and a third EBP was performed. Despite three EBP procedures, the headache recurred. Finally, we performed EBP directly near the right C2 nerve root with 10 cc of autologous blood. Her symptoms have improved considerably, sitting for about an hour. She was discharged and will be followed up 1 month later.
Conclusion
A careful evaluation of secondary headache conditions such as SIHH is important for pregnant woman with a migraine, because pregnancy can affect the frequency and magnitude of migraine. If the leakage site is detected, targeted EBP could be considered for the relief of refractory SIHH.
Reference
Parth U. et al., A review of spontaneous intracranial hypotension, Curr Neourol Neurosci Rep 2019; 19: 22.
Spontaneous intracranial hypotension headache (SIHH) is caused by low cerebrospinal fluid (CSF) pressure and it can involve symptoms such as nausea, vomiting, tinnitus, vertigo, hypoacusis, neck stiffness or photophobia. We report a case of targeted cervical EBP on direct leakage site for the treatment of SIHH overlapped with chronic migraine.
Case
A 37-year-old woman was referred to our pain with a worsening orthostatic headache from a month ago (7/10 on a numerical rating scale, NRS; 0=no pain, 10=worst pain imaginable). She had been suffering from chronic migraine. The postural headache suddenly occurred 18 months ago immediately after she had tried to remove a heavy object. At that time, she was in the early pregnancy, and the neurologist had thought that her migraine was exacerbated by pregnancy. She had received ultrasound-guided greater occipital nerve pulsed radiofrequency (PRF) in the 24th and 28th week of her pregnancy. However, after delivery, her postural headache became worse. To exclude SIHH, computed tomography myelography was done. It revealed a CSF leakage at dura-sleeve of right C2 nerve. We performed EBP at the C6/7 level with 7 cc of autologous blood, but the symptoms did not improve. Therefore, we decided a targeted EBP at the leakage site. The epidural catheter tip was positioned up to C2 level, and 5 cc of autologous blood was injected. There was a mild improvement in the symptom and a third EBP was performed. Despite three EBP procedures, the headache recurred. Finally, we performed EBP directly near the right C2 nerve root with 10 cc of autologous blood. Her symptoms have improved considerably, sitting for about an hour. She was discharged and will be followed up 1 month later.
Conclusion
A careful evaluation of secondary headache conditions such as SIHH is important for pregnant woman with a migraine, because pregnancy can affect the frequency and magnitude of migraine. If the leakage site is detected, targeted EBP could be considered for the relief of refractory SIHH.
Reference
Parth U. et al., A review of spontaneous intracranial hypotension, Curr Neourol Neurosci Rep 2019; 19: 22.
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