- Early Development of Spinal Cord Herniation in Spontaneous Intracranial Hypotension
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Seung Ae Kim, Soyoun Choi, Kyunghoon Yang, Hye Jin Yoo, Ja-Young Choi, Mi Ji Lee
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Headache Pain Res. 2026;27(3):231-240. Published online October 30, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0043
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 Abstract
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- Purpose: Spinal cord herniation has been recognized as a very rare, late complication of spontaneous intracranial hypotension (SIH). This study examined the incidence and timing of early spinal cord herniation in SIH and the factors associated with its development.
Methods
Data from a prospective cohort of patients with SIH at Seoul National University Hospital (2022–2024) were analyzed retrospectively. Eligible patients presented within 1 year of symptom onset, had a spinal longitudinal epidural collection, and had no spinal cord herniation at baseline. Kaplan–Meier analysis was used to estimate the cumulative incidence of spinal cord herniation, and Cox regression was used to evaluate risk factors.
Results
The study included 92 patients with SIH who presented within 1 year of onset (mean age, 40.6 years; 39.1% male). Spinal cord herniation was first detected in eight patients, a mean of 174.1±180.5 days after symptom onset. Its cumulative incidence reached 10.3% by 1 year and 14.2% by 2 years.
Conclusion
In patients presenting within 1 year of symptom onset with a type 1 leak, spinal cord herniation may develop earlier than previously recognized, even without neurological symptoms. Careful follow-up is essential to ensure timely, appropriate management. Caution is warranted, however, when generalizing these incidence estimates to the overall SIH population.
- Availability, Accessibility, and Utilization of Diagnostics and Therapeutics for Spontaneous Intracranial Hypotension in Asia
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Soyoun Choi, Woo-Seok Ha, Soo-Jin Cho, Aynur Özge, Betül Baykan, Esme Ekizoglu, Kiratikorn Vongvaivanich, Koichi Hirata, Linh Tuyen Nguyen, Mamoru Shibata, Min Kyung Chu, Otgonbayar Luvsannorov, Ryotaro Ishii, Shengyuan Yu, Shih-Pin Chen, Shuu-Jiun Wang, Takao Takeshima, Tsubasa Takizawa, Vinh Khang Nguyen, Wei-Ta Chen, Yen-Feng Wang, Soo-Kyoung Kim, Mi Ji Lee
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Headache Pain Res. 2025;26(2):142-153. Published online June 16, 2025
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DOI: https://doi.org/10.62087/hpr.2025.0005
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- Purpose: Recent advances in imaging techniques have significantly enhanced the diagnosis of spontaneous intracranial hypotension (SIH). However, these developments have been reported mostly in Europe and the United States. This study aimed to evaluate the availability and utilization of diagnostic and treatment modalities for SIH in Asia, through a survey of regional headache specialists.
Methods
A literature search was conducted using PubMed, and members of the Asian Regional Consortium for Headache were contacted. Participants completed a two-step survey evaluating the availability, accessibility, and frequency of SIH diagnostic and treatment methods in their countries and institutions. Descriptive statistics were used to analyze the data.
Results
Twenty physicians from eight countries completed both rounds of the survey. Lumbar puncture, brain magnetic resonance imaging (MRI), and spinal MRI are widely available across Asia, but real-time imaging techniques—such as dynamic computed tomography myelography and digital subtraction myelography—that precisely localize cerebrospinal fluid leaks are less accessible. Blind or semi-targeted epidural blood patches (EBPs) are available at most centers, but are easily accessible in only about half of cases. Surgical interventions are rarely available.
Conclusion
Most diagnostic methods for SIH are available in Asia, despite some regional disparities. The utilization of EBP and surgical interventions remains somewhat limited. This highlights the need for greater awareness and standardization of diagnostic methods in Asia.
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Citations
Citations to this article as recorded by  - Temporal and regional trends in the diagnosis and treatment of spontaneous intracranial hypotension: a systematic review
Woo-Seok Ha, Soyoun Choi, Mi-Kyoung Kang, Hye Yun Kim, Soo-Jin Cho, Soo-Kyoung Kim, Mi Ji Lee
The Journal of Headache and Pain.2026;[Epub] CrossRef - Diagnostic Value of Flow-Void Sign for Localizing Ventral Dural Defects in Spine MRI
Soo-Im Jang, Soyoun Choi, Seung Ae Kim, Hoe Jong Jeong, Ja-Young Choi, Mi Ji Lee
Journal of Clinical Neurology.2026; 22(3): 364. CrossRef - Current Concepts in the Diagnosis and Management of Spontaneous Intracranial Hypotension
Woo-Seok Ha, Min Kyung Chu
Journal of the Korean Neurological Association.2026; 44(2): 110. CrossRef - Surgical Treatment of Spontaneous Intracranial Hypotension: Clinical Characteristics and Outcomes in a Surgically Treated Cohort of Type 1 and Type 3 Leaks
Woo-Seok Ha, Hyun Woong Mun, Soomi Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Min Kyung Chu, Yoon Ha
Journal of Clinical Medicine.2026; 15(13): 4972. CrossRef - Recommendations for the Management of Spontaneous Intracranial Hypotension With Spinal Longitudinal Epidural CSF Collection
Soyoun Choi, Ian Carroll, Deborah I. Friedman, Peter G. Kranz, Eugene Lee, Manjit Matharu, Simy Parikh, Henrik W. Schytz, Marcio Nattan Portes Souza, Yen-Feng Wang, Hsiangkuo Yuan, Mi Ji Lee
Neurology.2026;[Epub] CrossRef
- Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data
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Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song
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Headache Pain Res. 2025;26(2):154-161. Published online June 19, 2025
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DOI: https://doi.org/10.62087/hpr.2025.0004
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6,638
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43
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- Purpose: Accurate case identification using administrative datasets relies on diagnostic coding, yet these codes’ accuracy for migraine remains uncertain. This study aimed to validate the diagnostic accuracy of International Statistical Classification of Diseases and Related Health Problems 10th Revision (International Classification of Diseases, ICD-10) codes for migraine, migraine without aura (MOA), and migraine with aura (MA) in the Korean National Health Insurance Service database.
Methods
We retrospectively reviewed the electronic medical records of 500 patients (migraine [G43.X], 200; MOA [G43.0], 200; MA [G43.1], 100) from secondary and tertiary hospitals between January 2019 and December 2024. Diagnoses confirmed by headache specialists using the International Classification of Headache Disorders, third edition served as the gold standard. Validation metrics included the positive predictive value (PPV), negative predictive value, sensitivity, specificity, and the kappa statistic. Diagnostic accuracy was assessed based on ICD-10 claim frequency and improved by combining diagnostic codes with prescriptions for migraine medications.
Results
A single ICD-10 claim had a PPV of 74.00%. Accuracy improved significantly with increased claim frequency (≥3 claims: PPV, 81.14%; sensitivity, 98.61%; specificity, 28.26%), particularly when combined with medication prescriptions (≥3 claims with medication: PPV, 94.96%; sensitivity, 91.87%; specificity, 85.37%). MOA (≥3 claims with medication: PPV, 95.20%) and MA (≥3 claims with medication: PPV, 93.65%) showed similar trends. Excellent inter-rater reliability was observed (kappa, 0.806–0.951), with no significant accuracy differences between hospitals.
Conclusion
Employing multiple claims and prescriptions improved the accuracy of migraine diagnoses using ICD-10 codes, supporting the use of this method in epidemiological studies and health policy decisions.
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Citations
Citations to this article as recorded by - Natural Diagnostic Classes of Headache Disorders: Latent Class Analysis of a Population-Based Study
Wonwoo Lee, Seok-Jae Heo, Jungyon Yum, Min Kyung Chu
Headache and Pain Research.2026; 27(1): 30. CrossRef - Adverse pregnancy outcomes in women with migraine: A retrospective multicenter cohort study
Inbal Akavian, Roie Alter, Hadar Rosen, Itay Nitzan, Ronit Calderon‐Margalit, Doron Kabiri
Pregnancy.2026;[Epub] CrossRef - Association between Psoriasis and Migraine in a Nationwide Cross-Sectional Study in Korea
Woo-Seok Ha, Soohyun Cho
Headache and Pain Research.2026; 27(3): 204. CrossRef - Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
Soo-Jin Cho
Headache and Pain Research.2025; 26(3): 171. CrossRef
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