09/07/2026
Early recognition of a CSF leak doesn’t just help the patient. It can help the whole healthcare system.
A patient with a CSF leak may present again and again with:
“migraine” “vertigo” “neck pain” “tinnitus” “fatigue” “brain fog”
But sometimes the biggest clue isn’t where the head hurts.
It’s what happens when the patient stands up.
Think about spontaneous intracranial hypotension (SIH) when a patient describes:
→ A headache that becomes worse when upright and improves after lying flat
→ A headache that is relatively mild on waking but builds through the day
→ A sudden thunderclap headache followed by an orthostatic pattern
→ A new daily persistent headache that initially had a positional component
Unexplained symptoms
And then listen for the symptoms around the headache:
Dizziness or disequilibrium.
Nausea
Muffled hearing or blocked ears
Tinnitus
Posterior neck pain
Cognitive difficulty
Fatigue
Photophobia
Visual blurring
The 2023 multidisciplinary consensus guideline recommends considering SIH in patients presenting with an orthostatic headache.
Because every missed clue can mean another appointment.
Another investigation.
Another treatment for the wrong diagnosis.
And another day that patient remains disabled.
Earlier recognition → earlier investigation → earlier appropriate treatment.
You’ve probably never heard of a CSF leak — I hadn’t either, until I had one.
It’s when the brain fluid leaks, causing severe headaches that ease when lying flat. Many go years undiagnosed.
If you’re a healthcare professional, please repost.
Awareness saves lives. 💙