Bilateral cervicothoracic transforaminal blood patches for persistent headache from spontaneous intracranial hypotension: A case report and review

David Walega*, Erin McComb, Joshua Rosenow

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Scopus citations


Objectives: Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective. Methods: Case report and review of the literature. Results and Discussion: In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalClinical Journal of Pain
Issue number4
StatePublished - May 2011



  • Spontaneous intracranial hypotension
  • epidural blood patch
  • headache
  • transforaminal injection

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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