Headache is the most common symptom of spontaneous intracranial hypotension (SIH). The present review focuses on data regarding headache features reported in the most relevant published articles and summarizes the main SIH headache features, namely, orthostatic headache, headache triggered by Valsalva maneuver, pattern of onset of headache, and location and quality of headache. Published data indicate that the clinical suspect of this disorder may be challenging, due to its protean presentation. Among the main implications for clinical practice, we suggest to suspect SIH in all patients with a new onset headache, as different forms of primary and secondary headache should be considered in the differential diagnosis of SIH, particularly cervicogenic headache, new daily persistent headache, and headaches precipitated by Valsalva maneuver. The clinical interview must include specific questions on the possible orthostatic feature of headache, although its absence should not make clinicians to reject the SIH hypothesis as headache cannot be orthostatic in each patient and in all periods of the natural history of the disease. Other disorders with orthostatic symptoms, such as in postural tachycardia syndrome (POTS) and persistent postural-perceptual dizziness (PPPD), should be considered in the differential diagnosis. Awareness that SIH can present with acute, sudden onset requires that clinicians working in the emergency settings should consider SIH in the range of diagnoses of thunderclap headache.

头痛是自发性颅内低血压（SIH）的最常见症状。本综述着重于最相关的已发表文章中报道的有关头痛特征的数据，并总结了SIH的主要头痛特征，即体位性头痛，Valsalva动作引发的头痛，头痛发作的方式以及头痛的位置和质量。公开的数据表明，由于这种疾病的蛋白质表现，这种疾病的临床可疑性可能具有挑战性。在临床实践的主要意义中，我们建议怀疑所有新发头痛的患者都患有SIH，因为在SIH的鉴别诊断中应考虑不同形式的原发性和继发性头痛，尤其是宫颈源性头痛，新的每日持续性头痛和瓦尔萨尔瓦动作引起的头痛。临床访谈必须包括有关头痛可能的体位性特征的具体问题，尽管缺少这种情况不应使临床医生拒绝SIH假说，因为在每个患者中以及在疾病的自然病史的所有时期中头痛都不能体位性。在鉴别诊断中，应考虑其他具有直立性症状的疾病，例如姿势性心动过速综合征（POTS）和持续性姿势性知觉头晕（PPPD）。意识到SIH可能会出现急性，突然发作的情况，要求在紧急情况下工作的临床医生应在诊断雷击性头痛的范围内考虑SIH。尽管缺乏头痛并不能使临床医生拒绝SIH假说，因为在每个患者中以及在疾病的自然病程的所有阶段，头痛都不能是直立性的。在鉴别诊断中，应考虑其他具有直立性症状的疾病，例如姿势性心动过速综合征（POTS）和持续性姿势性知觉头晕（PPPD）。意识到SIH可能会出现急性，突然发作的情况，要求在紧急情况下工作的临床医生应在诊断雷击性头痛的范围内考虑SIH。尽管缺乏头痛并不能使临床医生拒绝SIH假说，因为在每个患者中以及在疾病的自然病程的所有阶段，头痛都不能是直立性的。在鉴别诊断中，应考虑其他具有直立性症状的疾病，例如姿势性心动过速综合征（POTS）和持续性姿势性知觉头晕（PPPD）。意识到SIH可能会出现急性，突然发作的情况，要求在紧急情况下工作的临床医生应在诊断雷击性头痛的范围内考虑SIH。