Obstructive Sleep Apnea and CSF Leak Headache

By Vernon Rowe, M.D.

Severe headaches called CSF leak headaches can be caused by drainage of the spinal fluid from the protecting membranes covering the brain and spinal cord. This leads to a removal of the cushion normally present for the brain, and increased friction of the brain and its pain producing structures against the skull. What has not been known until just lately is patients with this type of headache have five times as much OSA as is present in the general population.

This could be related to the increased pressure in the central nervous system at night in patients with OSA. (ref) This increase in spinal fluid pressure associated with OSA could also be the reason the usual treatment of these patients with blood patch or surgical dural patch sometimes fails–OSA may not have been recognized in these patients.

OSA can be present in varying severity, from severe to mild to Upper Airway Resistance Syndrome, or UARS. But these classifications are arbitrary, and mild sleep disordered breathing in one person could be the reason for failure of treatment procedures and resultant refractory headaches in other patients. This is particularly true for those patients with Ehlers-Danlos Syndrome, who frequently don’t heal well from surgery, and oftentimes have abnormalities of the coverings of the brain. They also have an increased frequency of CSF leak headache. (ref)

So it is important to check for OSA in these patients, because even the “milder” forms of OSA may lead to chronic headache disorder (poster) and may make CSF Leak Headache harder to treat.

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