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Background and Aims Rebound intracranial hypertension (RIH) is a complication in patients with spontaneous intracranial hypotension (SIH) following surgical repair of a cerebrospinal fluid (CSF) dura leak. Patients suffer from debilitating headache in supine position, that is usually temporarily, but could last for years. Typically, acetazolamide offers relief by decreasing CSF production, but patients can be(come) refractory. Recently, glucagon-like peptide-1 (GLP-1) analogues were proposed to modulating CSF secretion and reducing intracranial pressure. No studies have evaluated their use for RIH treatment.

Methods A 46 year-old female patient with 1.5 years history of SIH developed RIH following surgical leak repair in 2017. She failed to maintain a good response of diuretics despite maximal dosage and failed other interventions. Pain score was high (NRS 6/10) and impacted quality of life, sleep and ability to work. In November 2021, she was initiated on Semaglutide 3 mg daily, and gradually increased over course of 3 months to 14 mg daily.

Results The patient reported an immediate pain relief after starting Semaglutide, with further improvement as dose was increased. At 3 months, she reported significantly lower pain scores (NRS 1/10), improved sleep, resumption of part-time work and absence of side-effects. She remained on this drug on daily basis and was able to stop diuretics intake.

Conclusions In this case, this GLP-1 agonist appeared to improve RIH symptom. Their role in the treatment of RIH should be evaluated in controlled studies to establish safety and efficacy. Consideration should be paid to how symptom improvement correlates (or not) with measurements of CSF pressure.