Treatment

Conservative measures

Long periods of bed rest, extra fluids, caffeine, or abdominal binders have weak evidence. Waiting too long can make diagnosis harder and may delay effective treatment. Early active treatment is often advised.

Epidural blood patches

An epidural blood patch (EBP) is the first-line treatment. A small amount of your own blood is injected into the space outside the dura in the spine. This can seal the leak and can also reduce CSF loss by gentle pressure.

Non-targeted EBP: usually in the lower back, often using 20 mL or more of blood.
Targeted EBP: given at the exact leak site using imaging guidance. Sometimes a fibrin sealant is added. A transforaminal route can reach leaks at the front or side.

What to expect:

Earlier and larger-volume patches tend to work better.
More than one patch may be needed.
Plan to lie flat for about 2 hours after the procedure.

Possible effects and risks:

Rebound intracranial hypertension can occur within 1 to 2 days. The headache may become worse when lying down and feel different in location. It often responds to acetazolamide.
Temporary back or shooting leg pain during or after the patch is common and usually settles within weeks.
Rare risks include epidural or subdural haematoma, infection, venous thrombosis, cauda equina syndrome, or inflammation if blood accidentally enters the CSF.

Targetted fibrin glue patches

If a specific leak is found, a doctor can inject a medical glue (fibrin sealant) into the epidural space near the leak, sometimes with a small blood patch. This can be done under fluoroscopy or CT, using interlaminar or transforaminal routes to reach front or side defects. It is often used when standard blood patches have not worked. Risks are similar to targeted EBPs.

Outlook (prognosis)

Many people improve or are cured with EBPs, targeted sealant, or treatment of a CSF-venous fistula. Some need repeat treatments. A small group have persistent or recurring symptoms and benefit from advanced imaging and specialist care. Earlier treatment improves the chance of full recovery and lowers the risk of long-term problems.