{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:49:28Z","timestamp":1789699768166,"version":"4.0.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Ministry of Health & Welfare, Republic of Korea","award":["HV22C0106"],"award-info":[{"award-number":["HV22C0106"]}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["2022R1A2C1091767"],"award-info":[{"award-number":["2022R1A2C1091767"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Headache Pain"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The epidural blood patch (EBP) is the treatment of choice for spontaneous intracranial hypotension (SIH). Studies have shown that targeted EBP is more effective than blind EBP. Additionally, a greater volume of injected blood during EBP has been associated with better therapeutic outcomes. However, symptoms such as back pain often prevent achieving the desired blood volume. This study aimed to analyse factors influencing the tolerable EBP volume, including structural, clinical, and psychological factors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective study included patients diagnosed with SIH who underwent single-level EBP at a tertiary care centre from 2019 to 2024. Data collected encompassed target levels, cross-sectional area, types of EBP, demographics, imaging findings, maximum intensity of orthostatic headache, Headache Impact Test-6, psychological state (Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9), and somatic symptom burden (Widespread Pain Index and Symptom Severity Scale). A linear mixed model (LMM) was used to investigate factors influencing the total injected blood volume, accounting for repeated EBP procedures per patient. Sensitivity analysis was performed to assess model robustness.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 103 EBP procedures from 53 patients (62% female; mean age, 39.9\u2009\u00b1\u200911.1 years) were analysed. The results of the LMM revealed that lower spinal levels (beta\u2009=\u20090.306, <jats:italic>P<\/jats:italic>\u2009=\u20090.029) and male sex (beta\u2009=\u20094.347, <jats:italic>P<\/jats:italic>\u2009=\u20090.024) were significantly associated with higher tolerable EBP volumes. Psychological factors or somatic symptom burden did not have a significant impact on the injected blood volume. In the sensitivity analysis, the number of EBP procedures (beta = -0.804, <jats:italic>P<\/jats:italic>\u2009=\u20090.001) was also significantly associated with lower tolerable EBP volume.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Lower spinal levels and male sex were associated with higher tolerable EBP volumes in patients with SIH. The trade-off between spinal level and tolerable EBP volume should be considered when developing targeted blood patch strategies and evaluating their efficacy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s10194-025-02015-1","type":"journal-article","created":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T22:01:51Z","timestamp":1744581711000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Lower spinal levels and male sex are associated with greater epidural blood patch volume in spontaneous intracranial hypotension"],"prefix":"10.1186","volume":"26","author":[{"given":"Woo-Seok","family":"Ha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JaeWook","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungwon","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jungyon","family":"Yum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soomi","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Jung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyung","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"issue":"3","key":"2015_CR1","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1212\/con.0000000000000979","volume":"27","author":"SJ Wang","year":"2021","unstructured":"Wang SJ (2021) Spontaneous intracranial hypotension. Continuum (Minneap Minn) 27(3):746\u2013766. https:\/\/doi.org\/10.1212\/con.0000000000000979","journal-title":"Continuum (Minneap Minn)"},{"issue":"12","key":"2015_CR2","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1111\/j.1468-2982.2008.01776.x","volume":"28","author":"WI Schievink","year":"2008","unstructured":"Schievink WI (2008) Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia 28(12):1345\u20131356. https:\/\/doi.org\/10.1111\/j.1468-2982.2008.01776.x","journal-title":"Cephalalgia"},{"issue":"2","key":"2015_CR3","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1093\/brain\/aww328","volume":"140","author":"JW Wu","year":"2017","unstructured":"Wu JW, Hseu SS, Fuh JL, Lirng JF, Wang YF, Chen WT, Chen SP, Wang SJ (2017) Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension. Brain 140(2):344\u2013352. https:\/\/doi.org\/10.1093\/brain\/aww328","journal-title":"Brain"},{"key":"2015_CR4","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-000021","author":"GL Pagani-Est\u00e9vez","year":"2019","unstructured":"Pagani-Est\u00e9vez GL, Cutsforth-Gregory JK, Morris JM, Mokri B, Piepgras DG, Mauck WD, Eldrige JS, Watson JC (2019) Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension. Reg Anesth Pain Med. https:\/\/doi.org\/10.1136\/rapm-2018-000021","journal-title":"Reg Anesth Pain Med"},{"key":"2015_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2018-100158","author":"R Martin","year":"2019","unstructured":"Martin R, Louy C, Babu V, Jiang Y, Far A, Schievink W (2019) A two-level large-volume epidural blood patch protocol for spontaneous intracranial hypotension: retrospective analysis of risk and benefit. Reg Anesth Pain Med. https:\/\/doi.org\/10.1136\/rapm-2018-100158","journal-title":"Reg Anesth Pain Med"},{"issue":"3","key":"2015_CR6","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1001\/jamaneurol.2020.4799","volume":"78","author":"L D\u2019Antona","year":"2021","unstructured":"D\u2019Antona L, Jaime Merchan MA, Vassiliou A, Watkins LD, Davagnanam I, Toma AK, Matharu MS (2021) Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and Meta-analysis. JAMA Neurol 78(3):329\u2013337. https:\/\/doi.org\/10.1001\/jamaneurol.2020.4799","journal-title":"JAMA Neurol"},{"issue":"5","key":"2015_CR7","doi-asserted-by":"publisher","first-page":"101138","DOI":"10.1016\/j.accpm.2022.101138","volume":"41","author":"PJ Zetlaoui","year":"2022","unstructured":"Zetlaoui PJ, Buchheit T, Benhamou D (2022) Epidural blood patch: A narrative review. Anaesth Crit Care Pain Med 41(5):101138. https:\/\/doi.org\/10.1016\/j.accpm.2022.101138","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"13","key":"2015_CR8","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1212\/WNL.0b013e318212ab43","volume":"76","author":"KI Cho","year":"2011","unstructured":"Cho KI, Moon HS, Jeon HJ, Park K, Kong DS (2011) Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology 76(13):1139\u20131144. https:\/\/doi.org\/10.1212\/WNL.0b013e318212ab43","journal-title":"Neurology"},{"issue":"4 Headache","key":"2015_CR9","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1212\/con.0000000000000193","volume":"21","author":"B Mokri","year":"2015","unstructured":"Mokri B (2015) Spontaneous intracranial hypotension. Continuum (Minneap Minn) 21(4 Headache):1086\u20131108. https:\/\/doi.org\/10.1212\/con.0000000000000193","journal-title":"Continuum (Minneap Minn)"},{"issue":"6","key":"2015_CR10","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1097\/00000542-200206000-00035","volume":"96","author":"JH Diaz","year":"2002","unstructured":"Diaz JH (2002) Permanent paraparesis and cauda equina syndrome after epidural blood patch for postdural puncture headache. Anesthesiology 96(6):1515\u20131517. https:\/\/doi.org\/10.1097\/00000542-200206000-00035","journal-title":"Anesthesiology"},{"key":"2015_CR11","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2019-100851","author":"S Narouze","year":"2019","unstructured":"Narouze S (2019) Epidural blood patch is an iatrogenic epidural hematoma: asymptomatic or symptomatic? This is the question. Reg Anesth Pain Med. https:\/\/doi.org\/10.1136\/rapm-2019-100851","journal-title":"Reg Anesth Pain Med"},{"key":"2015_CR12","doi-asserted-by":"publisher","unstructured":"Headache Classification Committee of the International Headache Society (IHS) (2018) The international classification of headache disorders, 3rd edition. Cephalalgia 38(1):1\u2013211. https:\/\/doi.org\/10.1177\/0333102417738202","DOI":"10.1177\/0333102417738202"},{"issue":"8","key":"2015_CR13","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1023\/a:1026119331193","volume":"12","author":"M Kosinski","year":"2003","unstructured":"Kosinski M, Bayliss MS, Bjorner JB, Ware JE Jr., Garber WH, Batenhorst A, Cady R, Dahl\u00f6f CG, Dowson A, Tepper S (2003) A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 12(8):963\u2013974. https:\/\/doi.org\/10.1023\/a:1026119331193","journal-title":"Qual Life Res"},{"issue":"10","key":"2015_CR14","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","volume":"166","author":"RL Spitzer","year":"2006","unstructured":"Spitzer RL, Kroenke K, Williams JB, L\u00f6we B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092\u20131097. https:\/\/doi.org\/10.1001\/archinte.166.10.1092","journal-title":"Arch Intern Med"},{"issue":"9","key":"2015_CR15","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","volume":"16","author":"K Kroenke","year":"2001","unstructured":"Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606\u2013613. https:\/\/doi.org\/10.1046\/j.1525-1497.2001.016009606.x","journal-title":"J Gen Intern Med"},{"issue":"5","key":"2015_CR16","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/acr.20140","volume":"62","author":"F Wolfe","year":"2010","unstructured":"Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600\u2013610. https:\/\/doi.org\/10.1002\/acr.20140","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"5","key":"2015_CR17","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1001\/jamaneurol.2018.4921","volume":"76","author":"T Dobrocky","year":"2019","unstructured":"Dobrocky T, Grunder L, Breiding PS, Branca M, Limacher A, Mosimann PJ, Mordasini P, Zibold F, Haeni L, Jesse CM, Fung C, Raabe A, Ulrich CT, Gralla J, Beck J, Piechowiak EI (2019) Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol 76(5):580\u2013587. https:\/\/doi.org\/10.1001\/jamaneurol.2018.4921","journal-title":"JAMA Neurol"},{"issue":"4","key":"2015_CR18","doi-asserted-by":"publisher","first-page":"745","DOI":"10.3174\/ajnr.A6016","volume":"40","author":"RI Farb","year":"2019","unstructured":"Farb RI, Nicholson PJ, Peng PW, Massicotte EM, Lay C, Krings T, terBrugge KG (2019) Spontaneous intracranial hypotension: A systematic imaging approach for CSF leak localization and management based on MRI and digital Subtraction myelography. AJNR Am J Neuroradiol 40(4):745\u2013753. https:\/\/doi.org\/10.3174\/ajnr.A6016","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"2015_CR19","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1213\/ANE.0b013e318218204d","volume":"113","author":"MJ Paech","year":"2011","unstructured":"Paech MJ, Doherty DA, Christmas T, Wong CA (2011) The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg 113(1):126\u2013133. https:\/\/doi.org\/10.1213\/ANE.0b013e318218204d","journal-title":"Anesth Analg"},{"issue":"1","key":"2015_CR20","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1148\/radiol.13120370","volume":"271","author":"EJ Ulbrich","year":"2014","unstructured":"Ulbrich EJ, Schraner C, Boesch C, Hodler J, Busato A, Anderson SE, Eigenheer S, Zimmermann H, Sturzenegger M (2014) Normative MR cervical spinal Canal dimensions. Radiology 271(1):172\u2013182. https:\/\/doi.org\/10.1148\/radiol.13120370","journal-title":"Radiology"},{"issue":"6","key":"2015_CR21","doi-asserted-by":"publisher","first-page":"671","DOI":"10.21037\/qims.2016.12.17","volume":"6","author":"JF Griffith","year":"2016","unstructured":"Griffith JF, Huang J, Law SW, Xiao F, Leung JC, Wang D, Shi L (2016) Population reference range for developmental lumbar spinal Canal size. Quant Imaging Med Surg 6(6):671\u2013679. https:\/\/doi.org\/10.21037\/qims.2016.12.17","journal-title":"Quant Imaging Med Surg"},{"issue":"1","key":"2015_CR22","doi-asserted-by":"publisher","first-page":"18471","DOI":"10.1038\/s41598-021-98038-0","volume":"11","author":"JH Lee","year":"2021","unstructured":"Lee JH, Kang KC, Kim KT, Kim YC, Chang TS (2021) Extent and characteristic of relationships in Canal dimension and Canal body ratio between cervical and lumbar spine. Sci Rep 11(1):18471. https:\/\/doi.org\/10.1038\/s41598-021-98038-0","journal-title":"Sci Rep"},{"issue":"3","key":"2015_CR23","doi-asserted-by":"publisher","first-page":"333102422114748","DOI":"10.1177\/03331024221147488","volume":"43","author":"PT Lin","year":"2023","unstructured":"Lin PT, Wang YF, Hseu SS, Fuh JL, Lirng JF, Wu JW, Chen ST, Chen SP, Chen WT, Wang SJ (2023) The SIH-EBP score: a grading scale to predict the response to the first epidural blood patch in spontaneous intracranial hypotension. Cephalalgia 43(3):3331024221147488. https:\/\/doi.org\/10.1177\/03331024221147488","journal-title":"Cephalalgia"},{"issue":"10","key":"2015_CR24","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1212\/wnl.57.10.1921","volume":"57","author":"D Sencakova","year":"2001","unstructured":"Sencakova D, Mokri B, McClelland RL (2001) The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57(10):1921\u20131923. https:\/\/doi.org\/10.1212\/wnl.57.10.1921","journal-title":"Neurology"}],"container-title":["The Journal of Headache and Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10194-025-02015-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s10194-025-02015-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s10194-025-02015-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T22:01:52Z","timestamp":1744581712000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejournalofheadacheandpain.biomedcentral.com\/articles\/10.1186\/s10194-025-02015-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2015"],"URL":"https:\/\/doi.org\/10.1186\/s10194-025-02015-1","relation":{},"ISSN":["1129-2377"],"issn-type":[{"value":"1129-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]},"assertion":[{"value":"10 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institution\u2019s Institutional Review Board (IRB No. 4-2024-1323). IRB waived informed consent as this study only used medical records retrospectively.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"WSH serves as junior editor of The Journal of Headache and Pain. MKC serves as a board member of The Journal of Headache and Pain.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}