Sarah Jividen, RN, BSN, is a freelance healthcare journalist and content marketing writer at Health Writing Solutions, LLC. She has over a decade of direct patient care experience working as a registered nurse specializing in neurotrauma, stroke, and the emergency room.

Huma Sheikh, MD, is a board-certified neurologist, specializing in migraine and stroke, and affiliated with Mount Sinai of New York.

Intracranial hypotension is a medical condition in which pressure or volume in the brain cavity is below normal levels due to low cerebrospinal fluid (CSF) levels. CSF is a clear, thick liquid that supports and cushions the brain and spinal cord. The reduced CSF causes a negative pressure within the skull, leading to headaches, dizziness, nausea, memory impairment, and other neurological symptoms.

This article discusses intracranial hypotension symptoms, causes, diagnosis, and treatment.

The most common symptom of intracranial hypotension is severe headaches.

Positional headaches feel better with lying down. They usually get worse throughout the day as a person has been standing up, and CSF leaks with the effects of gravity.

Other symptoms of intracranial hypotension include:

Intracranial hypotension stems from having too little CSF to cushion and support the brain. This decrease typically results from a CSF leak in a tissue layer called the dura mater (dura), the outermost layer of connective tissue that encompasses the meninges of the brain.

The dura helps to protect and surround the brain and spinal cord. A hole or tear in the dura is the cause of intracranial hypertension.

There are many reasons why a hole or tear may occur, such as:

Healthcare providers who suspect intracranial hypotension based on neurological symptoms may order one or more diagnostic tests, such as:

Fortunately, intracranial hypotension usually resolves on its own and requires no medical intervention in most cases.

However, in cases in which this condition does not heal itself or is more severe, other procedures may be necessary.

An epidural blood patch (EBP) is an injection of a person's own blood, called autologous blood, into the epidural space. This procedure helps by sealing the dural tear and stopping CSF fluid from leaking.

If EBP is ineffective after at least two tries, surgery by an experienced healthcare provider in surgical intracranial hypertension management may be an option.

Occasionally, patients may develop "rebound intracranial hypertension," or elevated CSF pressure after treatment. The most commonly used medication to counteract increased CSF pressure, in this case, is called Diamox (acetazolamide ), a diuretic used for reducing fluid buildup in the body.

The prognosis for most people who experience intracranial hypotension is positive. In most cases, this condition resolves independently without medical intervention. However, long-term prognosis and treatment become trickier if people need additional intervention.

The long-term prognosis depends on the severity of the dural tear or leak. If you have intracranial hypotension, it is essential to discuss the prognosis with your healthcare provider.

Coping with this condition varies and depends on its severity.

Managing mild and nonoperative intracranial hypotension symptoms often involves taking some downtime to allow the leak to heal. Other simple coping measures that your healthcare provider may recommend to manage uncomfortable symptoms include:

Discuss potential coping methods with your healthcare provider to see what they recommend for you.

Intracranial hypotension is a condition in which pressure in the brain cavity is below average due to low cerebrospinal fluid (CSF) levels. The most common symptom experienced by people with intracranial hypotension is headaches. Other symptoms may include nausea, neck pain, tinnitus, and sensitivity to light or sound.

Intracranial hypertension is caused by a hole or tear in the dura. This defect may occur as a side effect of an epidural, lumbar puncture, injury or trauma, spine surgery, or a weakness in the dura.

Fortunately, most people with intracranial hypotension require no medical intervention, and the condition resolves independently. However, in cases where this condition does not heal itself or is more severe, surgery or other procedures may be required, such as EBP patching or surgery.

Intracranial hypotension can be painful, frightening, and even debilitating. Fortunately, it typically resolves on its own and no invasive treatment is required. If intervention is needed, there are effective treatment options available.

This condition may take time to heal, so it's essential to rest and take care of yourself during the recovery process. Talk to your healthcare provider about specific treatments and coping mechanisms that are most appropriate for you.

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National Organization for Rare Disorders. Symptoms of spontaneous intracranial hypotension.

Spinal CSF Leak Foundation. Focus on causes of intracranial hypotension.

Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diagnosis and treatment to intracranial hypotension, including SIH. J Headache Pain. 2017;18(1):4. doi:10.1186/s10194-016-0708-8

Shin HY. Recent update on epidural blood patch. Anesth Pain Med. 2022;17(1):12-23. doi:10.17085/apm.21113

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