• Pollard H
• Pollard R

• Adult
• Affiliation / Bond University. Faculty of Society & Design. School of Psychology
• Affiliation / CQUniversity Sydney. School of Medical and Applied Sciences
• Affiliation(G) / Australia / New South Wales / Sydney
• Affiliation(G) / Australia / Queensland / Robina
• Hypotension, Orthostatic
• Intracranial Hypotension
• Male
• Open Access Document
• Telemedicine

Background: This paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor.

Case presentation: The intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days.

Conclusions: The significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature.

Author keywords: Spontaneous intracranial hypotension (SIH) — Chiropractic — Postural headache —  Telemedicine —  Diagnosis —   Adverse event

Author affiliations: HP: School of Medical and Applied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia; RP: School of Psychology, Faculty of Society & Design, Bond University, Robina, Queensland, Australia

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