P188 Headache management in spontaneous intracranial hypotension (SIH) after a whiplash in a car

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <h3>Background and Aims</h3> Spontaneous Intracranial Hypotension (SIH) results from non-iatrogenic cerebrospinal fluid (CSF) leakage, causing CSF hypovolemia. Characterized by orthostatic headaches that worsen upright and relieve when lying down, SIH is diagnosed through clinical history, symptoms, and imaging showing low CSF pressure ( <h3>Methods</h3> A 49-year-old female health professional developed severe holocranial headaches one week post- forceful, rapid back-and-forth movement of the neck, worsened in upright posture (EVN 10) and relieved when supine (EVN zero). Empirical meningitis treatment failed, and cisternography confirmed a CSF fistula. Initial treatment included rest, hydration, and analgesics: dipyrone (1g q4h), ibuprofen (600mg/day), pregabalin (up to 300mg/day), and escitalopram (10mg/day). Persistent symptoms led to hospitalization, venous hydration (2000ml/day), and a fluoroscopy-guided epidural blood patch (25ml blood at L1-L2 and L4-L5). The patient maintained EVN zero post-procedure and was discharged after 48 hours. Six months later, the patient developed kinesiophobia and catastrophizing behavior, avoiding rehabilitation and work despite continuing escitalopram. Psychological and physiotherapy support initiated after three months led to gradual improvement. One year post-accident, the patient regained autonomy and returned to work. <h3>Conclusions</h3> SIH management requires a multidisciplinary approach addressing physical and psychological aspects. Initial imaging should include contrast-enhanced MRI of the skull and spine, with myelography if needed. Predisposing factors include dural weaknesses, connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome), and hormonal influences, with women more frequently affected. Comprehensive care is crucial for optimal recovery.