To the Editor:
While I am glad the patient in the April 2011 Case of the Month article (“Intermittent headaches relieved by lying down”) found out she had intracranial hypotension, she would have been diagnosed much sooner had the emergency department provider sent her to see a headache specialist instead. I am a practicing PA in headache medicine, and just the patient's history, without any tests or imaging, pinpointed the problem to be either intracranial hypotension, or, less likely, Chiari malformation. When patients have headaches with associated symptoms, focusing on the headaches and letting the symptoms provide more clues is usually better than sending the patient to several different specialists. A headache specialist would also have eliminated the need for so many unnecessary tests. MRI with and without contrast of the head with attention to the brainstem would have been sufficient in this case.
Clay Shugart, PA-C