Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 23

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.


Post-Traumatic Headaches and Cerebrospinal Fluid Leaks


USE: Establish the importance of imaging and differential diagnosis in trauma patients


TITLE: Intracranial Hypotension Following Motor Vehicle Accident: An Overlooked Cause of Post Traumatic Head and Neck Pain


CITATION: Pain Practice, Volume 7, Issue 1, 2007, 47-52


AUTHORS: Marc A. Huntoon, MD & James C. Watson, MD, Departments of Anesthesiology and Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.


This article was published in Pain PracticePain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain that provide its readership with up-to- date knowledge of the research, evaluation methods, and techniques of pain management. The article reviews a case study of “a 60-year-old white female nurse [that] was involved in a motor vehicle accident in which she was a front-seat passenger in a collision with a large deer. By 24 hours after the collision, she manifested a severe occipital headache. Signs and symptoms were worse with sitting and absent in the supine position” (Huntoon & Watson, 2007, p. 48). After a thorough neurological evaluation and Brain MRI with contrast, the patient was diagnosed with an intracranial hypotension/dural CSF leak syndrome. She presented with the following additional symptoms/findings:


1: Fullness in the ears

2: Pupil were equal

3: Extraocular movements were intact

4: No loss of range of motion in the neck or point tenderness

5: Normal gait

6: No other neurological findings were present


She was scheduled and treated with a lumbar epidural blood patch and recovered completely.


“Because of the non-specific nature of many of these complaints and frequent associated psychological findings, patients are often assumed to be seeking compensation or to have significant pain amplification because of psychological distress” (Huntoon & Watson, 2007, p. 49).


“Patients who manifest post-traumatic headache symptoms as their major symptom, especially in association with other neurological signs or symptoms, should be considered for MRI evaluation with contrast” (Huntoon & Watson, 2007, p. 51).


Go to the following site for more information on the World Institute of Pain and Pain Practice


Reviewed by:

William J. Owens, Jr DC

President, AAMLP

American Academy of Medical-Legal Professionals



This review is provided for educational purposes only. It is not designed or intended to reproduce or replace the authors work. Readers are encouraged to obtain full licensed versions of the article as determined by Copyright Law. For information on how to obtain a licensed copy please contact the Academy directly. 2008

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