Cervical epidural blood patch for low CSF pressure headaches

Low CSF pressure headache is divided by the International Headache Society into three categories: 1) postdural puncture headache, 2) CSF fistula headache, and 3) headache attributed to spontaneous low CSF pressure.1 Finding an optimal way to “seal” a CSF leak with an epidural blood patch is often elusive.2 The difficulty lies in finding the site of leak (often lower cervical or upper thoracic).3 We present four patients with low CSF pressure headaches that responded to a cervical but not a lumbar epidural blood patch. ### Case reports. #### Patient 1. A 36-year-old woman developed orthostatic headaches 1 month after a motor vehicle accident. Brain CT and MRI were normal. CSF opening pressure was unobtainable. CT myelogram showed CSF leaks at C1 to C2 and C6 to T2. The patient was transferred to us with a diagnosis of low CSF pressure headache secondary to a traumatic dural tear. Conservative treatment with bedrest, hydration, nonsteroidal anti-inflammatory drugs, caffeine, and theophylline failed. Repeat lumbar puncture …