ORIGINAL RESEARCH published: 18 December 2018 doi: 10.3389/fneur.2018.01090 Frontiers in Neurology | www.frontiersin.org 1 December 2018 | Volume 9 | Article 1090 Edited by: Massimiliano Valeriani, Bambino Gesù Ospedale Pediatrico (IRCCS), Italy Reviewed by: Andreas Gantenbein, RehaClinic, Switzerland Stephanie J. Nahas, Thomas Jefferson University, United States *Correspondence: Francesco Bono f.bono@unicz.it Specialty section: This article was submitted to Headache Medicine and Facial Pain, a section of the journal Frontiers in Neurology Received: 17 August 2018 Accepted: 28 November 2018 Published: 18 December 2018 Citation: Bono F, Curcio M, Rapisarda L, Vescio B, Bombardieri C, Mangialavori D, Aguglia U and Quattrone A (2018) Cerebrospinal Fluid Pressure-Related Features in Chronic Headache: A Prospective Study and Potential Diagnostic Implications. Front. Neurol. 9:1090. doi: 10.3389/fneur.2018.01090 Cerebrospinal Fluid Pressure-Related Features in Chronic Headache: A Prospective Study and Potential Diagnostic Implications Francesco Bono 1,2 *, Maria Curcio 1 , Laura Rapisarda 1 , Basilio Vescio 3 , Caterina Bombardieri 4 , Domenica Mangialavori 5 , Umberto Aguglia 2 and Aldo Quattrone 3 1 Center for Headache and Intracranial Pressure Disorders, Magna Græcia University, Catanzaro, Italy, 2 Institute of Neurology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy, 3 Neurosciences Research Center, Magna Græcia University, Catanzaro, Italy, 4 Institute of Neuroradiology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy, 5 Institute of Ophthalmology, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy Objective: To identify the pressure-related features of isolated cerebrospinal fluid hypertension (ICH) in order to differentiate headache sufferers with ICH from those with primary headache disorder. Methods: In this prospective study, patients with refractory chronic headaches and suspected of having cerebrospinal fluid-pressure elevation without papilledema or sixth nerve palsy, together with controls, underwent 1-h lumbar cerebrospinal fluid pressure monitoring via a spinal puncture needle. Results: We recruited 148 consecutive headache patients and 16 controls. Lumbar cerebrospinal fluid pressure monitoring showed high pressure and abnormal pressure pulsations in 93 (63 %) patients with headache: 37 of these patients with the most abnormal pressure parameters (opening pressure above 250 mm H 2 O, mean pressure 301 mm H 2 O, mean peak pressure 398 mm H 2 O, and severe abnormal pressure pulsations) had the most severe headaches and associated symptoms (nocturnal headache, postural headache, transient visual obscuration); 56 patients with the less abnormal pressure parameters (opening pressure between 200 and 250 mm H 2 O, mean pressure 228 mm H 2 O, mean peak pressure 316 mm H 2 O, and abnormal pressure pulsations) had less severe headaches and associated symptoms. Conclusions: Nocturnal and postural headache, and abnormal pressure pulsations are the more common pressure-related features of ICH in patients with chronic headache. Abnormal pressure pulsations may be considered a marker of ICH in chronic headache. Keywords: isolated CSF hypertension, intracranial hypertension, one-hour lumbar CSF pressure monitoring via a spinal puncture needle, CSF pressure pulsations, chronic headache