[Intracranial Hypotension Surgery] Orthostatic Headache Recurring Even After University Hospital Treatment, Why Blocking the Exact Cause is the Answer

Patients who have fallen into despair due to frequent recurrences despite receiving spontaneous intracranial hypotension (SIH) treatment elsewhere visit our hospital exceptionally often. The biggest cause of failure is repeating procedures in the wrong places without finding the exact hole where cerebrospinal fluid (CSF) is leaking. We will now inform you of the clear standards for SIH surgery that completely eradicates the root of recurrence through an accurate target approach at Seoul Jeil Neurosurgery, which has abundant clinical experience.

Source: Recurrence Cause Analysis Report of Patients Visiting Our Hospital After Incomplete Procedures at Other Hospitals (Seoul Jeil Neurosurgery Internal Data, 2025)

People who have not experienced it can never understand the agony of having a splitting headache and severe nausea every time they stand up, forcing them to lie back down. Many people waste time enduring with painkillers, mistaking this orthostatic headache (a headache that worsens when standing and improves when lying down) for simple migraines or anemia.

Source: Mechanism of Orthostatic Headache and Misdiagnosis Rate Statistics in Patients with Spontaneous Intracranial Hypotension (Journal of the Korean Neurosurgical Society, 2023)

Intracranial hypotension is a disease that occurs when a tiny hole forms in the membrane surrounding the brain and spinal cord, causing the water (cerebrospinal fluid) that floats the brain to continuously leak toward the spine, leading the brain to sink downward. The principle is that as the pressure inside the brain drops by the amount of leaked fluid, the cerebral blood vessels and nerves are strongly pulled, causing extreme pain.

Source: Correlation Between Intracranial Pressure Drop Due to Cerebrospinal Fluid Leak and Cranial Nerve Traction Symptoms (Korean Society of Radiology, 2024)

A Perfect Intracranial Hypotension Surgery System that Blocks the Root Cause

It is useless to keep pouring water from the top without blocking the cracked gap in a leaking jar. To relieve symptoms, general hospitals first administer IV fluids or perform an 'epidural blood patch,' which involves injecting the patient's own blood into the approximate suspected area to coagulate and plug the hole.

Source: Guidelines for Primary Conservative Treatment of Intracranial Hypotension and Application of Epidural Blood Patch

There are quite a few cases where symptoms improve with this method. The biggest blind spot is that if the exact location of the CSF leak is not found without even a 1mm margin of error, the blood clot will dissolve a few days later, and the pain will return exactly as before. Our Seoul Jeil Neurosurgery thoroughly finds even pinhole-like microscopic leak sites through precise spinal imaging using a special contrast agent.

Source: Study on Improving the Accuracy of Diagnosing Cerebrospinal Fluid Leak Sites Using Special Contrast Myelography

Once an accurate target is secured, we establish the most appropriate and certain treatment plan according to the patient's condition and the size of the leak. For patients suffering from large, complex leaks or repeated recurrences that cannot be resolved with a general blood patch, we perform intracranial hypotension surgery (ligation) using a surgical microscope.

Source: Long-term Follow-up Results of Microscopic Ligation for Patients with Refractory Intracranial Hypotension

This is a highly precise surgery that involves opening a specific part of the spine microscopically, finding the torn dura mater (the outermost membrane surrounding the nerves), and directly suturing it or tightly sealing it with a special medical substance to permanently block the leak. Because a dedicated medical team equipped with cutting-edge equipment and rich clinical experience in CSF diseases directly performs the surgery, we can completely relieve patients of their deep anxiety about procedure failure.

Source: Success Rate of Permanent Blocking of Spontaneous Cerebrospinal Fluid Leak Through Direct Dural Suture and Ligation

A Successful Case of Intracranial Hypotension Surgery that Ended 3 Months of Despair

I particularly remember a male patient in his 40s a few months ago who, after lying in bed for 3 whole months, entered the consultation room in a wheelchair from an ambulance. Initially, he was prescribed simple migraine medication at a local internal medicine clinic, but as his symptoms worsened, he belatedly visited a university hospital emergency room.

Source: Transfer Case of an Intracranial Hypotension Patient Who Became Unable to Walk Due to Long-term Misdiagnosis and Neglect (Seoul Jeil Neurosurgery Internal Clinical Data, 2026)

Despite being diagnosed with SIH at the university hospital and receiving random blood patches twice, his severe headache recurred in just a week, leaving him in a desperate state where he completely lost his daily life. Because the fluid protecting the brain was completely empty and the brain had severely sunk, it was a very dizzying and urgent emergency situation that could have led to a brain hemorrhage if delayed even slightly.

Source: Analysis Report of a Severe Patient with Worsened Brain Sagging Phenomenon After Consecutive Failures of Epidural Blood Patches at Another Hospital

As a result of quickly conducting a precise contrast examination, we found that a large amount of CSF was gushing out from a very tricky location where the cervical spine (neck bone) and thoracic spine (back bone) connect. Since the surrounding tissues were already messy due to multiple blind needle procedures, we immediately switched to the most certain, precise intracranial hypotension surgery.

Source: Successful Indicator of Urgent Surgical Conversion for a Patient with a Large Cerebrospinal Fluid Leak in the Cervicothoracic Region

Through about an hour and a half of intensive surgery, we accurately located the leak site using a surgical microscope and sturdily ligated (sutured and tied) the torn membrane. Right after the surgery, the patient, opening his eyes in the recovery room, sat up in bed and shed tears he had been holding back, saying, "My head doesn't ache." The next day, he freely walked down the hospital corridor, and currently, he has perfectly returned to his original workplace without any pain.

Source: Clinical Data on Immediate Disappearance of Orthostatic Headache and Successful Walking Within 24 Hours After Microscopic Dural Ligation

Am I Also Leaking Cerebrospinal Fluid? Self-Diagnosis Checklist

If it is a severe pain that can never be resolved with simple headache pills sold at pharmacies, please carefully check the items below. If two or more apply, you should strongly suspect a CSF leak and immediately visit a neurosurgeon to objectively confirm the possibility of SIH surgery and treatment.

When waking up in the morning or standing, a severe, splitting headache occurs from the back of the neck to the crown of the head.

Even if the pain is extreme, it magically disappears or significantly decreases within 10 to 30 minutes if you lie down flat.

Along with the headache, you feel nauseous and experience severe gagging or vomiting symptoms.

You hear a high-pitched ringing sound (tinnitus) in your ears, or your ears feel muffled like when riding an airplane.

When you cough or strain your stomach in the restroom, your whole head rings and hurts as if it will explode.

Source: Guidelines for Initial Self-Diagnosis and Suspected Symptoms for Patients with Spontaneous Intracranial Hypotension (Korean Neurosurgical Society)

If you are lying down day after day in despair, staring only at the ceiling, please do not suffer alone and visit our Seoul Jeil Neurosurgery with a comfortable mind. A dedicated medical team with a deep understanding of CSF diseases and highly advanced microsurgical capabilities will safely and most quickly restore your lost normal daily life. If your symptoms are similar, early diagnosis before the disease worsens is the most important. Please book a detailed medical consultation via phone or our website right now.

Source: Clinical Importance of Early Imaging Examination for Patients with Suspected Symptoms of Cerebrospinal Fluid Leak

Frequently Asked Questions (FAQ) Regarding Intracranial Hypotension Surgery and Treatment

Q. Must intracranial hypotension surgery (ligation) be unconditionally performed immediately upon diagnosis?

A. We do not recommend surgical operation first to all patients. Patients in the early stages with a small amount of leakage improve excellently with IV fluid therapy or a blood patch injecting their own blood. We carefully proceed with the surgery of directly suturing the torn membrane only for severe patients who do not recover and continuously relapse even after repeating such conservative procedures multiple times.

Q. By exactly what principle does a blood patch (epidural blood patch) treat the condition?

A. It is a procedure that directly injects blood drawn from the patient's own arm into the space outside the spinal nerves (epidural space) where the CSF is leaking. The injected blood coagulates on the spot, forms a scab, and physically covers and blocks the torn hole. At the same time, it temporarily raises the pressure inside the spinal canal to float the sunken brain back to its safe position.

Q. If I visit the hospital, can you find the exact cause area on the same day?

A. It is very difficult to find microscopic leak sites using only general health check-up MRIs. An examination that takes precise images at time intervals after administering a special contrast agent into the spinal canal is essential. At our hospital, through this systematic system, we find the exact epicenter of the leak without error and establish a quick treatment plan.

Q. If I undergo surgery or a procedure, approximately how long is the hospitalization period?

A. In the case of a blood patch procedure, you can be discharged after absolute rest in bed during a short-term hospitalization of the same day or 1 night and 2 days. If proceeding with intracranial hypotension surgery that directly sutures the torn dura, depending on the patient's recovery speed, you will usually be hospitalized for about 3 to 5 days and safely discharged after observing the progress.

Q. Once the treatment is well finished, will it never recur again later?

A. If the leaking area is accurately found and tightly blocked, the recurrence rate at that site is extremely low. If you avoid actions that suddenly and sharply increase CSF pressure, such as abruptly lifting heavy objects or severely straining your stomach, and carefully follow the precautions guided by the hospital, you can maintain a healthy daily life.

Treating the severe orthostatic headache that pours down unbearably when standing as mere stress or anemia leads to neglecting the disease to a fatal state that threatens life as the brain severely sinks. Blind consumption of painkillers or random procedures that fail to find the exact leakage target will only repeat the pain and despair of recurrence. The absolute core of failure-free intracranial hypotension surgery lies in perfectly pinpointing the microscopic gap where the CSF leaks through medical imaging, and permanently blocking that hole through a blood patch or micro-ligation tailored to the patient's condition. If you want to forever end the painful days when you couldn't live a single day without lying down, we strongly recommend finding a neurosurgeon with unrivaled success know-how in diagnosing unexplained headaches and performing surgical operations for CSF to meet the most certain and safe solution.