Persistent severe headaches can sometimes indicate underlying health issues. If your headache improves when lying down or is accompanied by other symptoms, it may be caused by a cerebrospinal fluid (CSF) leak, or spontaneous intracranial hypotension. At New Jersey Brain and Spine, we are committed to providing compassionate care for patients who face persistent and challenging symptoms, guiding many toward effective treatment and a better quality of life.
Your brain and spinal cord are surrounded by a fluid membrane called the dura mater, which acts as a cushion and shock absorber. The dura mater protects your brain and spinal cord from injury and infection. A CSF leak occurs when there’s a tear or hole in the dura mater, allowing cerebrospinal fluid to leak out. Tears can result from head injuries due to falls or accidents, surgical procedures like lumbar punctures or epidurals, bone spurs that develop along the spine and damage the membranes, strenuous exercise, vigorous coughing, and sometimes they occur with no apparent cause.
CSF leaks may cause a variety of symptoms, including:
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Headaches that improve when lying down
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Neck stiffness or pain
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Nausea, dizziness, or “brain fog”
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Tinnitus (ringing in ears)
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CSF rhinorrhea (clear fluid draining from nose or ears)
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Vision changes
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Fatigue
Symptoms also vary depending on where the leak is located. You may notice clear fluid draining from your nose or one or both ears. Other possible signs include a loss of smell, loss of appetite, vomiting, sensitivity to light, and seizures. Many of these symptoms overlap with other conditions, so it’s important to see a specialist if you experience one or more of them.
CSF leaks, especially those that happen spontaneously, are rare. Because the main symptom is a headache, CSF leaks can be mistaken for other issues like migraines, tension headaches, sinus infections, or allergies. Even when a CSF leak is suspected, diagnosis can be difficult because imaging tests may not always reveal the exact leak location, or the doctor interpreting the results may have limited experience recognizing CSF leaks. Additionally, if the cerebrospinal fluid pressure is normal when your physician expects low pressure, the diagnosis may be delayed. For these reasons, a specialist’s expertise is crucial to accurately identify the cause of symptoms and confirm a CSF leak through testing and imaging.
Diagnosis and Evaluation: What to Expect at your appointment with New Jersey Brain and Spine
At New Jersey Brain and Spine, we take a thoughtful, step-by-step approach to your care. From your first appointment, our doctors carefully review your medical history, symptoms, and any imaging you’ve already had. We will discuss your symptoms, perform a detailed exam, and—if necessary—order additional tests to better understand what’s happening.
There are several diagnostic tools available to confirm a CSF leak. These include:
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Lab testing: beta-2 transferrin and glucose tests
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Diagnostic tests: Lumbar puncture (spinal tap), cisternogram scan
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Imaging tests: computerized tomography scans, magnetic resonance imaging, digital subtraction angiography, and myelography
Treatment Options for a CSF Leak
Treatment recommendations will vary based on the cause, severity, and location of the CSF leak. Leaks resulting from traumatic injuries may require different treatments than spontaneous leaks. Leaks caused by an underlying condition need a plan to address the root cause.
Generally, small, uncomplicated leaks heal naturally within a couple of days with rest, pain relievers, and an increase in fluids. Some doctors recommend caffeinated drinks because research shows they can increase the amount of CSF in the body.
For headaches that last longer than a week, a non-surgical procedure called a blood patch can be performed to block the leak. Your physician will draw a small amount of blood from your arm and then inject it into the area near the site of the leak. When the blood clots, it seals the hole in the dura mater, stopping the leak and restoring normal pressure.
Surgery is typically recommended for leaks associated with high CSF pressure or defects like bone spurs, as well as when symptoms don’t improve after conservative treatment and monitoring. Surgical options may include:
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Endoscopic repair
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Craniotomy
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Lumbar drain
