I have had a continuous headache/migraine for the past 8 1/2 years. They began 2 days after I had a spinal tap when I was diagnosed with MS. They do not change with position. My local neorologist has tried 60+ medications and they have not phased the migraines. He also did 3 occipital nerve blocks. 6 weeks ago he sent me to the Pain Mngt Center at UAB. I believe it to be an excellent hospital. The Dr did another spinal tap and said that my pressure was low. It was an 8. What is the normal range? How low is an 8? What could cause it to be low? Is there medication to treat this? They decided against doing a blood patch since my headaches were not positional related. They are now doing a series of occipital nerve blocks. 8 over the next 8 weeks. What are treatment optionsif this does not work?
Thanks for your advise.
We usually like to see spinal pressures at 10-20 cmH20, up to 25 if a patient is obese. A pressure of 8 is on the low side, but is not cause for great concern. Although you said the HA are not positional, I wonder if you have a chronic spinal fluid leak or some kind of Chiari malformation in which the lower part of your brain/brainstem is situated just a tad lower than normal patients and was pulled down a bit when you had you first spinal tap. An MRI should have picked this up if it was a Chiari malformation, but it's something to consider if you have neurologic symptoms such as slurred speech or difficulty swallowing as surgery can be helpful. If the pressure is due to a spinal leak then of course a blood patch should help.Some people have tried caffeine in the past.There is no pill or other medical therapy to "bring up" the spinal fluid pressure. In fact, some normal people have pressures that are on the low side.
I'm not familiar with the pain clinic at UAB, but the neurology dept is strong so I've heard. As you have tried "60+ meds" for pain, someone there should be able to go through them all with you and help suggest some kind of combination therapy that you haven't tried before. Topamax and IV depacon are things that are tried in this pain clinic as well as a DHE pump. Chronic daily headaches are very difficult to treat and I'm glad you're at a pain center you have confidence in. Best of luck with the nerve blocks.
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