Skip to content


The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

Open Access

O009. Early pain relief from orthostatic headache and hearing changes, assessed with the visual analogue scale, in spontaneous intracranial hypotension after epidural blood patch in Trendelenburg position: 28 case reports

  • Enrico Ferrante1Email author,
  • Valentina Sangalli1,
  • Elena Olgiati2,
  • Fabio Rubino3 and
  • Elio Agostoni1
The Journal of Headache and Pain201516(Suppl 1):A124

Published: 28 September 2015


Visual Analogue ScaleComplete ReliefIntracranial HypotensionEpidural Blood PatchSpontaneous Intracranial Hypotension


Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), diffuse pachymeningeal enhancement on brain MRI and low CSF pressure. Hearing change (HC) is a frequent finding. Epidural blood patch (EBP) is now the most recommended available treatment. Our study aimed at investigating the EBP efficacy on OH and HC by asking patients to rate their OH and HC at different time intervals with a visual analogue scale (VAS).

Materials and methods

Twenty-eight consecutive patients with SIH were treated with EBP in Trendelenburg position. Two Psychologists asked them to rate, on a VAS, the intensity of their OH and HC before, 24 hours after, and two months after treatment.


A significant improvement in OH and HC was found (p < .001) 24/48 hours after EBP. When followed-up, all patients showed complete relief from OH. Four patients out of 16 reported very mild HC.

Discussion and conclusions

To the best of our knowledge, this is the first time a specific pain assessment with VAS was conducted before and after EBP, showing a fast improvement of OH and HC in a large group of SIH patients. Importantly, patients have been followed up for two months and 13-25 months after discharge, which confirmed the effect to be complete and long-lasting. In a future work, it may be worth monitoring patients’ changes over time with multiple follow-ups, also involving larger patients sample in a multicentric study.

Written informed consent to publication was obtained from the patient(s).

Authors’ Affiliations

Neurosciences Department, Niguarda Cà Granda Hospital, Milan, Italy
Imperial College London, Department of Medicine, Division of Brain Sciences, London, UK and University of Milan-Bicocca, Department of Psychology, Milan, Italy
Anaesthesiology Department, Niguarda Cà Granda Hospital, Milan, Italy


  1. Ferrante E, Arpino I, Citterio A, et al: Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension. Eur J Neurol. 2010, 17: 715-719. 10.1111/j.1468-1331.2009.02913.x.View ArticlePubMedGoogle Scholar
  2. Mokri B: Spontaneous Low Pressure, Low CSF Volume Headaches: Spontaneous CSF Leaks. Headache. 2013, 53: 1034-1053. 10.1111/head.12149.View ArticlePubMedGoogle Scholar
  3. Ferrante E, Arpino I, Citterio A, et al: Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in Trendelemburg position pre-medicated with acetazolamide. Clin Neurol Neurosurg. 2009, 111: 699-702. 10.1016/j.clineuro.2009.06.001.View ArticlePubMedGoogle Scholar


© Ferrante et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.