Continuing Medical Education

Headache: The Highs & Lows of CSF Pressure Problems

Renaissance Raleigh North Hills Hotel, Renaissance Raleigh North Hills Hotel, Raleigh, North Carolina

Course Description

This is a one and a half day course on CSF pressure problems as a secondary cause of headache, including intracranial hypotension and hypertension.  It is intended to inform local neurologists, headache specialists, and other health care professionals including neurosurgeons, anesthesiologists, neuroradiologists, and pain management physicians about the varied presentations and the current state of diagnosis and treatment for disorders resulting from CSF pressure problems.  In particular, these disorders can present as migraine, chronic migraine, new daily persistent headache, spontaneous intracranial hypotension (SIH), idiopathic intracranial hypertension, Chiari I malformations and intracranial hypertension as a complication of CSF leak treatment.  SIH can also be iatrogenic status post lumbar punctures, epidural catheter placement and epidural injections.

Day 1 of this course will incorporate SIH, its clinical presentation, association with connective tissue disorders and POTS, MR imaging findings, the workup for detecting leaks and the types of leaks to look for.  The approach to the diagnosis with CT guided lumbar puncture, myelograms, and minimally invasive techniques including fibrin glue and blood patching as well as surgical intervention will be discussed.

Day 2 of the course will discuss intracranial hypertension.  Intracranial hypertension is the opposite side of the same coin as intracranial hypotension and can present as positional headache but also as chronic daily migraine.  Its clinical presentation, imaging findings, medical treatment and venous stenting will be discussed.

Invited speakers include experts in neuroradiology, neurology-ophthalmology, internal medicine, headache, orthopedic surgery, and neurosurgery. Many cases will be presented throughout the discussions.


At the conclusion of this activity, participants should be able to:

1) describe the clinical presentation, imaging manifestations of high and low CSF pressure disorders

2) present the current state of minimally and surgical treatment of CSF low pressure disorders

3) present the current treatment, medical and invasive treatments for high pressure CSF disorders

In support of improving patient care, the Duke University Health System Department of Clinical Education and Professional Development is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the health care team.

Credits for technologists will be requested for approval.


Duke University Health System Department of Clinical Education & Professional Development designates this activity for a maximum of 10 AMA PRA Category 1 Credit(s)TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Nursing CE: Duke University Health System Department of Clinical Education and Professional Development designates this activity for up to 10 credit hours for nurses. Nurses should claim only credit commensurate with the extent of their participation in this activity.

For more information contact:

Debbie Griffin
Department of Radiology
Duke University Medical Center


Timothy Amrhein, M.D.
Associate Professor of Radiology
Director, Spine Intervention Service
Duke University Medical Center

Christopher Brown, M.D.
Assistant Professor of Orthopaedic Surgery
Assistant Professor in Neurosurgery
Duke University Medical Center

Jeremy Cutsforth-Gregory, M.D.
Assistant Professor of Neurology
Mayo Clinic

Scott Davies, M.B.B.S.
Neurological Intervention and Imaging Service of Western Australia

Vinay Deshmukh, M.D., FACS
Neurotrauma & Specialty Surgery Credentialing Committees
Carolinas Medical Center
Lead Neurosurgeon for NASCAR

Deborah Friedman, M.D., MPH
Professor of Neurology and Ophthalmology
Founding Director of Headache and Facial Pain Program
University of Texas Southwestern Medical Center

Andrew Griffin II, M.D.
Neurointerventional Fellow
Duke University Medical Center

J. Michael Hazenfield, M.D.
Assistant Professor of Radiology
University of Cincinnati Medical Center

Isaac Karikari, M.D.
Associate Professor of Neurosurgery
Associate Professor of Orthopaedic Surgery
Duke University Medical Center

Peter Kranz, M.D.
Associate Professor of Radiology
Chief, Division of Neuroradiology
Duke University Medical Center

Linda Gray Leithe, M.D.
Course Director
Associate Professor of Radiology
Duke University Medical Center

Patrick Luetmer, M.D.
Professor of Radiology
Mayo Clinic

Michael Malinzak, M.D., Ph.D.
Medical Instructor of Radiology
Duke University Medical Center

Vincent Martin, M.D.
Professor of Medicine
Director, UC Headache and Facial Pain Center
University of Cincinnati Medical Center

Simy Parikh, M.D.
Neurology Fellow, Jefferson Headache Center
Thomas Jefferson University

Jill Rau, M.D., Ph.D.
Post-doctoral Research in Headache Neurology
Mayo Clinic

Wouter Schievink, M.D.
Professor of Neurosurgery
Director, Cerebrospinal Fluid Leak Program
Cedars-Sinai Medical Center




*Schedule subject to change

Saturday, March 21

7:00 a.m.             Breakfast
7:25 a.m.             Welcome – Linda Gray Leithe, M.D.

7:30 a.m.             Clinical Diagnosis of Spontaneous Intracranial Hypotension (SIH) – Simy Parikh, M.D.
7:55 a.m.             Brain Imaging for SIH – Michael Malinzak, M.D., Ph.D.
8:20 a.m.             Spine Imaging for SIH – Peter Kranz, M.D.
8:45 a.m.             When SIH is Excluded:  Alternative Causes of Chronic Daily Headache and How to Differentiate it from SIH – Vincent Martin, M.D.

9:10 a.m.             Q&A
9:25 a.m.             Break

9:40 a.m.             When SIH is Excluded:  When to Consider POTS as an Alternative Diagnosis – Jeremy Cutsforth-Gregory, M.D.
10:05 a.m.           Beyond Standard Myelography:  Hyperdynamic Techniques in CTM and DSM – Patrick Luetmer, M.D.
10:30 a.m.           Cases – J. Michael Hazenfield, M.D.
10:55 a.m.           Research Highlights and Important Publications – Jill Rau, M.D., Ph.D.

11:20 a.m.           Q&A
11:35 a.m.           Lunch

12:20 p.m.          Percutaneous CSF Leak Treatment – Linda Gray Leithe, M.D.
12:45 p.m.          Surgical Techniques:  Intradural Approach – Wouter Schievink, M.D.
1:10 p.m.            Surgical Techniques:  Extradural Approach – Christopher Brown, M.D.

1:35 p.m.             Break

1:50 p.m.             Surgical Techniques:  Combined Approach – Vinay Deshmukh, M.D., FACS
2:15 p.m.             Surgical Techniques:  CSF-Venous Fistulas – Isaac Karikari, M.D.

2:40 p.m.             Q&A
3:00 p.m.             Adjourn meeting

5:30 p.m.             Cocktail reception


Sunday, March 22

7:00 a.m.             Breakfast

7:30 a.m.             Literature Review of Efficacy for Epidural Blood Patching – Timothy Amrhein, M.D.
7:55 a.m.             Challenges and Lessons to Learn Initiating a CSF Leak Practice – Scott Davies, M.B.B.S.
8:20 a.m.             Clinical Signs and Symptoms of High CSF Pressure – Deborah Friedman, M.D., MPH
8:45 a.m.             High CSF Pressure Imaging – J. Michael Hazenfield, M.D.

9:10 a.m.             Q&A
9:30 a.m.             Break

9:45 a.m.             High Pressure Medical Treatment – Deborah Friedman, M.D., MPH
10:10 a.m.           Venous Stenting for High Pressure – Andrew Griffin II, M.D.
10:35 a.m.           Rebound High Pressure Post Procedure – Michael Malinzak, M.D., Ph.D.

11:00 a.m.           Q&A
11:30 a.m.           Adjourn


Registration fees include: Breakfast and breaks on Saturday and Sunday as well as lunch and a cocktail party on Saturday

Prior to March 6 registration fees are:

Physicians:  $495
PA/NP – $195
Nurses/Technologists/Medical Students – $95
Residents/Fellows – $95

On or after March 6 there will be a $50 late fee added.

There is a $25 administrative fee for cancellation.

No refunds will be given after March 13th

For more information contact:

Debbie Griffin


Renaissance Raleigh North Hills Hotel
4100 Main at North Hills Street
Raleigh, NC 27609



A block of room for this meeting are available at a rate of $174.00 per night at the Renaissance Raleigh North Hills Hotel.

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Renaissance Raleigh North Hills Hotel
4100 Main at North Hills Street
Raleigh, NC 27609


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