Spontaneous Intracranial Hypotension Manifesting Orthostatic Headache Worsen by Playing the Trombone

We present the case of a 13-year-old Japanese girl with no previous medical history who presented with a gradually worsening series of orthostatic headaches. We diagnosed spontaneous intracranial hypotension, which worsened by playing the trombone and its Valsalva maneuver effect. She was admitted to our hospital and treated with rest and hydration, and discharged on day 14 without any headaches during the admission. However, her headache recurred when she played trombone, so she stopped it. She now plays percussions, and no headaches recurred for a year. Our case’s headache may have been further exacerbated by cerebrospinal fluid (CSF) leakage due to CSF pressure increase by the Valsalva maneuver while playing the trombone.