If your head pounds within minutes of standing up and eases when you lie flat, you already know something specific is wrong - even if every scan has come back "normal" and every clinician has landed on migraine, tension, or anxiety. A spontaneous spinal cerebrospinal fluid (CSF) leak causes exactly this pattern, and it is missed for months or years far more often than it should be.
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At Neuroveda Health, connecting these dots is what we do. We recognize CSF leaks for what they are, especially in the hypermobile and complex patients who are most at risk, guide you to the right diagnostic imaging and definitive care, and treat the whole connective-tissue picture that makes leaks happen and come back.
Seattle clinic with telehealth options for Washington State. We coordinate closely with the neuroradiology and neurosurgical centers that perform blood patches and repairs.
What is a spinal CSF leak?
A spinal cerebrospinal fluid (CSF) leak is a tear or hole in the tough membrane (the dura) that holds the fluid cushioning your brain and spinal cord. When that fluid escapes at the level of the spine, the brain loses some of its support and can sag slightly downward, producing a distinctive set of symptoms and a condition known as spontaneous intracranial hypotension (SIH).
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The hallmark is a positional, or orthostatic, headache: pain that worsens when you are upright and improves when you lie down, often within minutes. Spinal CSF leaks are not rare, but they are underdiagnosed - the pattern is easy to miss, and many patients cycle through years of migraine or psychiatric labels before the real cause is found.
Common signs of a spinal CSF leak
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A headache that is worse when upright and better lying down - often felt at the back of the head or base of the skull
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Neck pain and stiffness, or pain between the shoulder blades
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Nausea, light and sound sensitivity, and headaches that build as the day goes on
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Ringing in the ears (tinnitus), muffled or changed hearing, or a feeling of pressure
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Dizziness, balance problems, or brain fog and cognitive slowing
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Profound fatigue that tracks with how long you have been upright
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Symptoms that started after a fall, a procedure involving the spine, or seemingly out of nowhere
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Not every positional headache is a CSF leak, and not every leak is perfectly positional - which is exactly why an experienced eye matters. If this pattern sounds like your life, you are in the right place.
Why CSF leaks are so often missed - and why hypermobile patients are most at risk.
A spinal CSF leak rarely happens in a vacuum.
It shows up most in the same connective-tissue-fragile bodies that struggle with a whole cluster of interrelated conditions - the exact complexity Neuroveda Health was built to untangle.
Hypermobility and Ehlers-Danlos (hEDS/HSD) - the collagen differences in hEDS weaken and thin the dura, and can cause it to balloon outward (dural ectasia), leaving the membrane far more prone to spontaneous tears. Hypermobile patients are a well-recognized high-risk group for spontaneous CSF leaks.
Craniocervical and upper cervical instability (CCI) - the same ligament laxity that destabilizes the skull-neck junction travels with the dural fragility behind many leaks.
Tethered cord syndrome - another connective-tissue-related spinal condition we commonly see in the same patients.
MCAS (mast cell activation syndrome) - mast cell mediators degrade the connective-tissue matrix and disrupt the barriers around the brain and spinal cord. Emerging work suggests calming mast cell activity may be one of the less invasive ways to help prevent leaks from recurring.
Dysautonomia and POTS - low CSF volume and autonomic dysregulation overlap heavily, and the dizziness, fatigue, and headache of each can mask the other. We offer complete in-office autonomic nervous system testing - one of only three locations in Washington State with the full four-test evaluation.
Most clinics look at the headache alone and stop at a normal head CT. We look at the whole person - which is often what finally surfaces a leak that has been hiding in plain sight.
How we help you get diagnosed
The most important clue to a spinal CSF leak lives in your history - the timing, the positional pattern, and the company the symptoms keep. Getting the diagnosis right changes everything: it ends years of being dismissed and opens the door to treatment that actually works.
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Our evaluation starts the way all care at Neuroveda starts: with a real conversation about your whole story. From there we help you pursue the right imaging in the right order and get you to the specialists who confirm and locate a leak.
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Pattern-based clinical evaluation - mapping your headache pattern, triggers, and the full symptom picture against what CSF leaks and intracranial hypotension actually look like, and screening for the hypermobility, MCAS, and instability that raise your risk
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Guidance on brain and spine imaging - a brain MRI with and without contrast can show the telltale signs of intracranial hypotension (the "SEEPS" findings), and dedicated spine imaging - CT myelography, dynamic CT myelography, or digital subtraction myelography - is used to pinpoint the leak or a CSF-venous fistula
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Coordination with neuroradiology and neurosurgery - because locating and sealing a leak is highly specialized work, we help you get to the centers that do it well, with a clear picture of your connective-tissue background in hand
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Comorbidity workup - autonomic nervous system testing for POTS, evaluation for MCAS and hypermobility, and targeted labs from our full specialty testing menu, so nothing driving your symptoms gets missed
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You do not need to arrive with a diagnosis or a stack of answers. Sorting out what is actually going on is our job - together.
Integrative support for spinal CSF leaks
The definitive fix for a confirmed spinal CSF leak - an epidural blood patch, fibrin sealant, venous embolization, or surgical repair - is performed at specialized neuroradiology and neurosurgical centers, not in an integrative clinic. Where Neuroveda comes in is everything around that procedure: getting you correctly recognized and referred, treating the connective-tissue vulnerability underneath, and supporting a nervous system and body worn down by months of illness.
Our approach blends evidence-based modern medicine with Ayurvedic and Chinese medicine tradition, and every plan is built for your specific picture.
Recognize and refer
Our first job is often the one no one else has done: taking your positional headache seriously, naming the likely cause, and connecting you to the imaging and the interventional teams that confirm, locate, and seal a leak. We stay in the loop as a coordinating partner, not a dead end.
Address what makes leaks happen - and recur
Leaks in connective-tissue-fragile bodies tend to come back when the underlying vulnerability goes untreated. We work on the foundation:
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Connective-tissue and hypermobility care - a whole-body plan for the hEDS/HSD that weakens the dura in the first place
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MCAS evaluation and treatment - because settling overactive mast cells may reduce the tissue breakdown that drives recurrent leaks
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Nutritional and foundational support - Ayurvedic consultation and treatments and targeted nutrition to support tissue integrity and healing
Steady the nervous system and ease the symptom burden
Living with intracranial hypotension keeps the whole system on high alert, and the comorbidities pile on. We help you downshift and recover:
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Autonomic and POTS care for the dysautonomia that so often rides along, including IV therapy for hydration and volume support when appropriate
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Fascial Counterstrain - a gentle, non-forceful manual therapy well suited to sensitive, pain-worn bodies and to the neck and spine tension that accompanies these conditions
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Acupuncture and Chinese herbal medicine and the Safe and Sound Protocol (SSP) for pain, sleep, vagal tone, and a nervous system stuck in threat mode
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The goal is simple: get the leak found and fixed by the right hands, and treat the whole body so you actually recover - and stay recovered.
Care from people who truly get it.
CSF leak care at Neuroveda is provided by a team that lives in the world of connective-tissue and complex neurological conditions every day - and understands how easily this diagnosis gets missed.
ND, LAc
is a naturopathic physician and acupuncturist specializing in hypermobility spectrum disorders (HSD/EDS), craniocervical instability, dysautonomia, and MCAS/immune dysregulation, with regenerative joint medicine and our Therapeutic Plasma Exchange (TPE) program. Her focus on the connective-tissue instability behind CSF leaks makes her a natural lead for these patients.
is a Stanford-trained, board-certified family physician providing complex chronic care management for EDS, MCAS, POTS, and long COVID, alongside myofascial pain treatment - the overlapping picture most CSF leak patients carry.
treats MCAS, POTS, and hEDS through a functional medicine lens, with deep expertise in the gut, hormones, and the whole-body foundation that supports tissue healing.
brings specific experience with spinal fluid leaks, upper cervical instability, hypermobility and EDS, MCAS, and dysautonomia - and as a person living with hEDS herself, her lived experience shapes how our whole program understands these conditions. (Currently not accepting new patients.)
Behind them stands our full integrative team: functional medicine, Ayurveda, Chinese medicine, and integrative neurology. Because complex conditions deserve more than one set of eyes.
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“Never have I been listened to so deeply in all my 36 years.”
What your first visit looks like
Connect.
Fill out our inquiry form and tell us your story. We'll match you with the right provider and confirm scheduling and pricing up front.
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Deep-dive consultation.
Your initial visit is a real evaluation - your whole history, your symptom pattern, what you've tried, and what most needs answering. No 12-minute appointments here.
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A personalized plan.
Every first visit ends with a collaboratively-determined assessment and plan - imaging to pursue, referrals to make, comorbidities to treat, and a clear path forward. You stay in the driver's seat.
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We see patients in person at our Seattle clinic and via telehealth for Washington State residents. Many patients travel to us for evaluation, then continue much of their care from home.
Frequently asked questions about about spinal CSF leaks
What are the symptoms of a spinal CSF leak?
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The hallmark symptom is an orthostatic (positional) headache - pain that gets worse within minutes of standing or sitting up and improves when you lie down, often felt at the back of the head or base of the skull. Other common symptoms include neck pain and stiffness, nausea, sensitivity to light and sound, ringing in the ears or changes in hearing, dizziness, brain fog, and profound fatigue that tracks with how long you have been upright. Symptoms often build as the day goes on.
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What causes a spontaneous spinal CSF leak?
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A spontaneous spinal CSF leak happens when the dura - the membrane holding in the fluid around the brain and spinal cord - tears or is breached at the level of the spine, sometimes through a bone spur or a CSF-venous fistula. Underlying connective-tissue weakness is a major risk factor, which is why leaks are more common in people with hereditary connective-tissue disorders such as Ehlers-Danlos and Marfan syndromes. Loss of fluid lowers the pressure and support around the brain, producing intracranial hypotension.
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Why are CSF leaks more common in people with hypermobility or hEDS?
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In hypermobile Ehlers-Danlos syndrome, the collagen that gives connective tissue its strength is more fragile, which can weaken and thin the dura and cause it to balloon outward (dural ectasia). That fragile membrane is far more prone to spontaneous tears. Highly comorbid mast cell activation can further break down the surrounding tissue. This is why we evaluate for hypermobility and MCAS in anyone with an unexplained CSF leak - and why treating those root factors matters for preventing recurrence.
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How is a spinal CSF leak diagnosed?
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Diagnosis starts with the history and symptom pattern, then moves to imaging. A brain MRI with and without contrast can reveal the signs of intracranial hypotension (summarized by the acronym SEEPS - subdural collections, meningeal enhancement, venous engorgement, pituitary enlargement, and brain sagging). To find the leak itself, dedicated spine imaging is used - CT myelography, dynamic CT myelography, or digital subtraction myelography. Because these studies are specialized, we guide you to the right imaging and the centers that perform it.
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Does Neuroveda perform epidural blood patches or CSF leak surgery?
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No. Sealing a confirmed leak - through an epidural blood patch, fibrin sealant, venous embolization, or surgery - is highly specialized work performed at neuroradiology and neurosurgical centers. Our role is to recognize the leak, guide accurate diagnosis, coordinate your referral to those specialists, and treat the whole connective-tissue and comorbidity picture around the procedure so you recover well and are less likely to leak again.
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Can a spinal CSF leak heal on its own?
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Some leaks improve with conservative measures such as rest, hydration, and caffeine, but these often do not resolve the problem permanently, and many leaks need a targeted procedure to seal. What we can do from the start is make sure you are correctly diagnosed rather than dismissed, connect you to definitive treatment quickly, and address the underlying tissue fragility that determines whether a leak comes back.
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Why do CSF leaks keep coming back?
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Recurrence is more likely when the underlying connective-tissue vulnerability goes untreated. In hypermobile patients, the same dural fragility that allowed the first leak remains, and unmanaged mast cell activation can keep degrading the tissue. That is why our approach does not stop at the referral - we treat the hEDS/HSD, MCAS, and whole-body factors that make leaks recur, as part of a long-term plan.
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Do I need a diagnosis before booking?
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No. Many of our patients come to us suspecting a CSF leak without confirmation, or with positional headaches nobody has explained. Recognizing the pattern and guiding the workup is part of what we do. If you already have a confirmed leak, we build on that - supporting your recovery and treating the comorbidities and tissue factors so you stay well.
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Do you offer telehealth for CSF leak care?
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Yes. We're licensed to treat patients located in Washington State, with telehealth available pending provider availability. Much of CSF leak care - history-taking, coordinating imaging and referrals, and managing comorbidities - fits telehealth well, while in-office services like autonomic testing take place at our Seattle clinic.
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Will insurance cover my care?
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Neuroveda is a direct-pay clinic; we provide Superbills and billing codes so you can seek reimbursement from your insurer. Imaging and procedures performed at outside hospitals and specialty centers are billed separately by those providers and are frequently covered by insurance. We keep our pricing transparent so you can plan ahead; provider rates are listed on each provider's page.
You deserve care that connects the dots
You've spent enough time carrying a folder of normal scans while your head pounds every time you stand up. Whether you are newly suspicious that a CSF leak explains it all, or you have a confirmed leak and need a team that treats the whole picture around it - we're here for all of it. We're here for you.