Clinical Reasoning: An underrecognized etiology of new daily persistent headache IH is an important cause of new daily and persistent headache that remains an elusive diagnosis even among experienced neurologists given the varied presenting clinical and radiographic manifestations, often leading to misdiagnoses including migraine, tension type headache, medication overuse, or malingering. This patient's case highlights the importance of recognition and awareness of SIH secondary to CSF-venous fistula as often these may not be evident on more commonly utilized neuroimaging modalities, including CT myelogram. There is some evidence that the presence of a hyperdense paraspinal vein on CT myelogram may provide a diagnostic clue to this entity.5 CSF-venous fistulas appear relatively unresponsive to EBP, further emphasizing the importance of a correct diagnosis as in our experience they are exquisitely amenable to surgical interventions including sacrificing a nonappendicular nerve root or venous communication obliteration.10,12 Such treatments may provide complete pain relief for patients whose pain was otherwise intractable.
#science #chiropractor #chiropractic #research #education #evidence based #patient centered #interprofessional #collaborative #rehabilitation #public health #spinal health #musculoskeletal health #ethics #pain #function #disability #QOL #knowledgetranslation
