Analysis of the Epidemiologic Profile, Prevalence, and Incidence of Migraine out of 15,490 Spontaneous Intracranial Hypotension Patients from a Multicenter Record Database (TriNetX)
Arashleen Pannu1, Victor Wang2, Simy Parikh2, Mario Peres3, Hsiangkuo Yuan2
1Sidney Kimmel Medical College at Thomas Jefferson University, 2Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, 3Institute of Psychiatry, University of São Paulo
Objective:

To investigate the incidence of migraine following spontaneous intracranial hypotension (SIH) diagnosis in patients with additional risk factors.

Background:

Treatment-refractory headaches in SIH patients may be due to new-onset migraine rather than ongoing cerebrospinal fluid (CSF) leak. Risk factors, including Ehlers-Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS), lumbar puncture (LP), and motor vehicle collisions (MVC), may contribute to the refractoriness.

Design/Methods:

Using TriNetX, a cohort with ≥2 instances of either SIH, spinal CSF leak, or intracranial hypotension (excluding cranial and iatrogenic CSF leak) was created (n=15,490) and subgrouped by the following risk factors: EDS (n=507), POTS (n=301), past MVC (n=1,664), and prior lumbar puncture (LP) (n=206). In addition to the demographics, we evaluated the risk of newly diagnosed (1-year post-SIH diagnosis) migraine based on each risk factor.

Results:
In this SIH cohort, 15,490 patients were identified (prevalence 0.012%). The mean age was 53.6±19.7, 8,416 (54.3%) were female, 10,379 (67.0%) were white, 3,534 (22.8%) had migraine, and 2,317 (15.0%) were prescribed antimigraine agents. The risks of a new migraine diagnosis by risk factors were: SIH alone (3.82%), EDS (14.9%), POTS (15.0%), prior MVC (2.07%), and prior LP (6.85%).
Conclusions:

We describe the demographics of an SIH cohort and its 1-year incidence of migraine after SIH diagnosis. SIH with comorbid EDS or POTS has a higher risk of new migraine diagnosis than SIH alone, prior MVC, and prior LP. This study is limited by reporting bias and the inability to confirm diagnoses or verify in what setting diagnoses are made.

10.1212/WNL.0000000000205713