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Methodical history taking may help in timely diagnosis of spontaneous intracranial hypotension
  1. Jin Irie1 and
  2. Kensuke Shiga2
  1. 1 Emergency and Critical Care, Tsugaru Health Coop Kensei Hospital, Hirosaki, Japan
  2. 2 Neurology, Matsushita Memorial Hospital, Moriguchi, Japan
  1. Correspondence to Dr Jin Irie, jin-irie{at}


Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.

  • headache (including migraines)
  • neuroimaging

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  • Contributors JI designed the study and wrote the initial draft of the manuscript. KS critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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