REBOUND Intracranial HYPERTENSION (RIH)

“Although RIH is sparsely reported, in our experience it is not an uncommon complication of epidural blood patching.”

— Dr. Amrhein, Dr. Gray and Dr. Kranz

Rebound intracranial hypertension (RIH) caused by a rebound increase in CSF pressure is experienced by many patients after a CSF leak is successfully sealed. In other words, the pendulum may swing rapidly in the opposite direction leading to excess volume of CSF. This means that in contrast with a low-pressure headache, a new high-pressure headache may develop which feels significantly worse when the patient is flat. Many people find the location of the head pain switches from occipital to frontal.

Patients with increased head pain/pressure when they are flat following an epidural patch should seek medical attention. In rare cases, other causes of headache may be considered that can also increase intracranial pressure. In addition, relief from a high-pressure headache can often be achieved through the administration of certain medications designed to reduce CSF pressure. These medications include: acetazolamide (diamox), amiloride, furosemide (lasix), hydrochlorothiazide (HCTZ), spironolactone, , and topiramate.

Helpful natural tips to manage RIH

Avoid caffeine
Avoid sugar
Avoid sodium
Drink tea made from dandelion leaves
Drink tea made from fresh ginger or ginger products to relieve nausea
Sleep with a wedge pillow or raise the head of your bed using books or blocks under the bed legs.

Key Notes

Some patients could experience RIH for a lengthy or indeterminate period of time. In most patients though, RIH resolves over weeks to a few months.
It is advisable to discuss RIH and how to deal with it with the physician prior to treatment to avoid patch failure.

Sources & Suggested Reading