title: Application of IHS criteria to headache attributed to spontaneous intracranial hypotension in a large population.
abstract: We applied the recent International Headache Society (IHS) criteria for headache related to spontaneous intracranial hypotension (SIH) to 90 consecutive patients with a final diagnosis of SIH confirmed by cerebral magnetic resonance imaging with contrast. Orthostatic headache (developing within 2 h of standing or sitting up) was present in 67 patients (75%) but appeared within 15 min after standing or sitting-as required by point A of the criteria-in only 53 (59%). Forty-four (49%) patients did not satisfy point A, including 22 (24%) with non-orthostatic headache and 14 (16%) with headache developing >or= 15 min after standing or sitting up; 80 (89%) did not satisfy point D. Only three (3%) patients had headache fully satisfying the IHS criteria. These findings indicate that the current IHS criteria do not capture most patients with SIH-associated headache. Excluding the requirement for response to epidural blood patch (criterion D) and considering headaches appearing within 2 h of sitting or standing up would capture more patients.
authors.affiliation: Headache Centre, Neurological Department, [corrected] Neurological Institute, C. Besta Foundation, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mea
authors.forename: L
authors.initials: L
authors.lastname: Chiapparini
authors.forename: M
authors.initials: M
authors.lastname: Savoiardo
authors.forename: A
authors.initials: A
authors.lastname: Franzini
authors.forename: D
authors.initials: D
authors.lastname: Grimaldi
authors.forename: G
authors.initials: G
authors.lastname: Bussone
authors.forename: M
authors.initials: M
authors.lastname: Leone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006261:Headache / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D038622:Internationality; D019585:Intracranial Hypotension / Q000145:classification / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012955:Societies, Medical / Q000592:standards*; D055815:Young Adult