{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:16:28Z","timestamp":1774340188887,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to summarize the available evidence regarding the clinical value and trend over time of lumbar cerebrospinal fluid (CSF) opening pressure utilization to diagnose spontaneous intracranial hypotension (SIH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>CSF opening pressure obtained via lumbar puncture is one of the diagnostic criteria for SIH based on the International Criteria for Headache Disorders, 3rd Edition (ICHD\u20103), but it has questionable utility as an initial investigation for diagnosing SIH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors performed a systematic literature review and meta\u2010analysis. PubMed\/MEDLINE, Scopus, and Cochrane Library were searched from inception to October 2022. Original studies and case series in English reporting three or more patients with suspected or known SIH and CSF pressure measurement were included. Meta\u2010analyses and meta\u2010regression were used to calculate pooled estimates and examine the impact of age, sex, and publication year on outcomes, including CSF pressure\u2009&lt;\u200960\u2009mm CSF, orthostatic headache, and positive findings on brain magnetic resonance imaging (MRI), spinal imaging, and radionuclide studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For every 1\u2010year increase in the year of publication, the odds of reporting low CSF pressure decreased by 6.20% (adjusted odds ratio [aOR]\u2009=\u20090.94, aOR 95% confidence interval [CI]\u2009=\u2009[0.90, 0.97],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), the odds of reporting a positive brain MRI increased by 4.67% (aOR\u2009=\u20091.05, aOR 95% CI\u2009=\u2009[1.01, 1.09],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026), and the odds of reporting orthostatic headache increased by 9.13% (aOR\u2009=\u20091.09, aOR 95% CI\u2009=\u2009[1.03, 1.15],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Each 1% increase in the percentage of patients with orthostatic headache was associated with a 3.13% increase in the odds of low CSF pressure (aOR\u2009=\u20091.03, aOR 95% CI\u2009=\u2009[1.01, 1.05],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Similarly, as the percentage of patients with low CSF pressure increased by 1%, there was a 2.53% increase in the odds of orthostatic headache (aOR\u2009=\u20091.03, aOR 95% CI\u2009=\u2009[1.01, 1.04],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). It was estimated that 31.9% of patients with SIH had normal opening pressure (95% CI\u2009=\u2009[24.0%, 40.8%], prediction interval\u2009=\u2009[5.0%, 80.5%]). Every 1% increase in the percentage of patients with positive brain MRI was associated with a 5.25% increase in the odds of positive spinal imaging (aOR\u2009=\u20091.05, aOR 95% CI\u2009=\u2009[1.00, 1.11],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047). Age and positive radionuclide study did not significantly impact the outcomes measured. The corresponding\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      for each outcome was reduced by controlling for study\u2010wide covariates believed to impact the prevalence of each outcome. Sensitivity analyses did not reveal discrepancies in results when studies requiring outcomes of interest were removed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis found that recent studies indicate a reduced reliance on opening pressure for diagnosing SIH. Rather, results suggest an increasing reliance on contrast\u2010enhanced brain MRI, spine imaging, and clinical features for SIH diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.15060","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T19:34:00Z","timestamp":1760556840000},"page":"517-530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The contribution of lumbar puncture opening pressure in the diagnosis of spontaneous intracranial hypotension: A\u00a0systematic literature review and meta\u2010analysis"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-6787","authenticated-orcid":false,"given":"Simy K.","family":"Parikh","sequence":"first","affiliation":[{"name":"Department of Neurology Thomas Jefferson University  Philadelphia Pennsylvania USA"},{"name":"Department of Neurology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance R.","family":"Deline","sequence":"additional","affiliation":[{"name":"Independent scholar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan","family":"McCreary","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Department of Neurology  Dallas TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farnaz","family":"Amoozegar","sequence":"additional","affiliation":[{"name":"Clinical Neurosciences University of Calgary Cumming School of Medicine  Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9354-9486","authenticated-orcid":false,"given":"Tim J.","family":"Amrhein","sequence":"additional","affiliation":[{"name":"Department of Radiology Duke University  Durham North Carolina 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