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Cerebrospinal Fluid Pressure Measurements in
Patients Experiencing
Severe, Benign
Headaches
Khandhar S.M., Friedman D.I.
Posted August 2003
Presented at: 45th Annual Scientific Meeting
American Headache Society
June 19-22, 2003; Chicago, Illinois
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Objectives: To determine the range of opening pressures in patients
being evaluated in the Emergency Department for headache, whose discharge diagnosis
was a benign headache disorder.
Conclusions: Cerebrospinal fluid pressure may be elevated in patients
with benign headache disorders and is not necessarily indicative of idiopathic
intracranial hypertension. Possible reasons for elevated pressure include valsalva
maneuver associated with crying during a severe headache, improper positioning,
faulty examination technique, or an unrecognized effect of severe head pain or its
treatment on cerebrospinal fluid pressure. Because of its retrospective, our study
is limited by the quality of documentation available. A prospective study using a
standardized technique, a uniform reporting form for the LP, and final diagnosis
based in IHS diagnostic criteria would be useful. However, in the “real world”,
diagnoses are often made based on LP data that are collected in the ED setting.
We conclude that cerebrospinal fluid pressure measurements may be elevated in the
setting of an acute headache, and a high opening pressure does not always signal a
worrisome intracranial process.
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