Headache with features of intracranial hypotension

Features of intracranial hypotension include positional headache (worse when upright, better when lying down)

Most appropriate imaging: MRI head C+/C- (contrast allows for evaluation for pachymeningeal enhancement)

Alternatives:

  • MRI thoracic spine C+/C- (contrast preferred but not required; goal is to identify possible dural tear, contrast can help differentiate enhancing epidural venous distension)

ACR appropriateness criteria


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