Spontaneous Intracranial Hypotension

Understanding the Condition & Finding Lasting Relief

What Is Spontaneous Intracranial Hypotension (SIH)?

Spontaneous Intracranial Hypotension (SIH) is a condition caused by a cerebrospinal fluid (CSF) leak, leading to a drop in intracranial pressure.

This results in severe headaches that typically worsen when upright and improve when lying down. SIH can also cause dizziness, nausea, visual disturbances, and cognitive issues.

Unlike traumatic CSF leaks, SIH occurs spontaneously without an obvious injury. It may result from minor spinal trauma, connective tissue disorders, or degenerative changes in the spine. If left untreated, SIH can significantly impact quality of life, causing persistent neurological symptoms.

How Spontaneous Intracranial Hypotension Impacts Your Life

Without treatment, SIH can significantly impact daily activities, including:

  • Chronic pain and fatigue leading to reduced mobility and difficulty with work or daily tasks.

  • Cognitive issues (brain fog, memory problems, poor concentration) affecting mental function.

  • Disruption of daily activities due to severe headaches and dizziness.

  • Emotional distress from ongoing symptoms and reduced quality of life.

Common Causes of Spontaneous Intracranial Hypotension

  • Spinal CSF Leak


    A small tear in the dura leads to cerebrospinal fluid loss, reducing brain cushion and causing symptoms.

    Learn More

  • Connective Tissue Disorders


    Conditions like Ehlers-Danlos Syndrome can weaken the dura, increasing the risk of spontaneous leaks.

  • Degenerative Spinal Changes


    Bone spurs or disc issues can create small dural tears.

  • Trauma or Strain


    These can sometimes trigger a CSF leak.

    Learn More

  • Post-Medical Procedure Leaks


    Though primarily spontaneous, some cases may follow previous spinal surgeries, lumbar punctures, or epidural anaesthesia.

How Mr Gordan Grahovac Can Help

As a Consultant Neurosurgeon & Complex Spinal Surgeon, Mr Grahovac is highly experienced in diagnosing and treating Spontaneous Intracranial Hypotension (SIH). Whether through non-invasive therapies, targeted pain relief, or minimally invasive surgical interventions, he creates a personalised treatment plan to stop CSF leaks, restore normal pressure, and relieve symptoms.

To accurately diagnose SIH and locate the source of the CSF leak, Mr Grahovac may perform:

  1. Medical History & Physical Examination – Assessing symptoms, headache patterns, and neurological function.

  2. Brain & Spine MRI with Contrast (Gadolinium Enhancement) – Identifies brain sagging, CSF leaks, and signs of low intracranial pressure.

  3. Digital Subtraction Myelography (DSM) or CT Myelography – Advanced imaging to pinpoint exact leak location.

His Diagnostic Process:

Treatment Options for SIH

Mr Grahovac offers a comprehensive, stepwise approach to treating SIH, starting with conservative management and progressing to targeted interventions when necessary.

    • Bed Rest & Hydration – Lying flat can temporarily relieve symptoms and may allow minor CSF leaks to heal spontaneously.

    • Caffeine Intake – Caffeine acts as a vasoconstrictor, helping increase CSF production and temporarily relieve headaches.

    • Increased Fluid & Salt Intake – Helps stabilise CSF production and circulation, potentially aiding symptom relief.

    • Postural Adjustments – Avoiding straining, bending forward, or prolonged sitting/standing to minimise further CSF loss.

    • Abdominal Binders (For Select Cases) – Some patients may benefit from binders or compression garments, which help increase CSF pressure in mild cases.

  • Medications for Symptom Relief – Includes:

    • Pain relief medications (NSAIDs, acetaminophen, or opioids if necessary).

    • Anti-nausea drugs (for dizziness and nausea).

    • Corticosteroids (may help reduce inflammation around the leak).

    • Medications to regulate CSF pressure (e.g., theophylline, acetazolamide in select cases).

    • CSF Diversion Procedures (For Severe or Chronic Cases) – In rare cases where multiple blood patches fail, a lumbar or ventriculoperitoneal (VP) shunt may be used to stabilise CSF pressure and prevent recurrent leaks.

    • Surgical CSF Leak Repair – Direct microsurgical repair of a spinal dural tear using suturing or grafting techniques. This is reserved for persistent, recurrent, or large leaks.

    • Dural Graft Surgery – Dural reinforcement with grafting material (such as autologous fat, fascia, or synthetic dural patches) to strengthen the dura and prevent further CSF leaks.

What Patients Are Saying

Frequently Asked Questions: SIH

  • SIH often presents with a severe headache that worsens when upright and improves when lying down. Other symptoms may include neck pain, dizziness, nausea, visual changes, and cognitive issues (brain fog, difficulty concentrating).

  • Some mild CSF leaks may heal with bed rest, hydration, and conservative management. However, persistent cases often require an epidural blood patch or fibrin glue patch for resolution.

    • Non-invasive treatments (bed rest, hydration, caffeine) – 1–2 weeks.

    • Epidural blood patch – Immediate to a few days for symptom improvement.

    • Surgical repair – Several weeks to a few months, depending on complexity.

  • While SIH is not usually life-threatening, severe, untreated cases can lead to chronic pain, cognitive issues, and long-term disability. Seeking medical care early can prevent complications.

  • Treatment depends on severity of your SIH:

    • Mild cases – Bed rest, hydration, and caffeine.

    • Moderate cases – Epidural blood patch or fibrin glue patch.

    • Severe cases – Surgical repair of the CSF leak.

Take the First Step Towards Relief

Spontaneous Intracranial Hypotension doesn’t have to limit your life. Whether you need conservative management or advanced treatment, Mr. Gordan Grahovac is here to help.

Book a consultation today and start your journey towards lasting relief.