Characterization of the Prevalence and Treatment Strategies of Migraine in Patients with Refractory Spontaneous Intracranial Hypotension
Ahmed Taha Shahzad1, Victor Wang2, Hsiangkuo Yuan2, Simy Parikh2
1Sidney Kimmel Medical College, Thomas Jefferson University, 2Jefferson Headache Center
Objective:
To characterize the prevalence and management of prior or active migraine and probable migraine in patients diagnosed with and treated for spontaneous intracranial hypotension (SIH).
Background:
Spontaneous intracranial hypotension (SIH), characterized by postural headache in the setting of spinal cerebrospinal fluid (CSF) leak or CSF hypotension, is often misdiagnosed as migraine. Patients with SIH may be susceptible to the worsening or development of concomitant headache disorders. In particular, the prevalence of migraine and management strategies for concomitant, new-onset migraine in patients with SIH remains understudied.
Design/Methods:
Single-center, IRB-approved, retrospective chart review of the electronic medical records of 100 patients aged ≥ 18 with a confirmed or probable diagnosis of SIH evaluated at a tertiary headache center by one SIH specialist from January 1, 2021 to September 1, 2023. Demographics (age, sex, race/ethnicity); migraine history and development, previous and current medication list, and clinical condition (monthly headache days, usual pain intensity, quality of life (MIDAS), acute medication use days, etc.) were extracted.
Results:
In the preliminary analysis of 25 patients with confirmed or suspected SIH (mean age = 49, standard deviation = 16), 44% had a past history of migraine or probable migraine. In patients with a history, 82% continued to experience migraine after SIH onset. In contrast, 24% of those with no past history developed new-onset migraine after SIH onset. Altogether, regardless of migraine history, the prevalence of active migraine in patients after SIH onset was 56%. Furthermore, 84% of all patients (100% of patients with active migraine) were on migraine medications at some point in their treatment course.
Conclusions:
Early data suggests that some patients with SIH may have a history of migraine. Even in the absence of migraine history, a subset of patients with SIH may develop new-onset migraine. Migraine medications are a possible management strategy for migraine in patients with SIH.