患者は生来健康な26歳，女性．職業はキャビンアテンダント．勤務中に乗客の重い荷物を全身の力で頭上の棚に持ち上げ，その夜より強い頭痛と嘔気が生じた．頭痛や嘔気は立位や夕方に増強し，臥位で改善した．computed tomography（CT）脊髄造影で髄液漏出が認められ，脳脊髄液減少症と診断された．治療として硬膜外生理食塩液持続注入を行い，症状・activities of daily living（ADL）ともに改善がみられた．合併症が多いと考えられる硬膜外自家血注入を行わず，安全かつ効果的に治療することができた．また，非外傷性の脳脊髄液減少症は発症契機が不明なことが多いが，本症例では重い荷物を頭上に持ち上げるようなストレッチ運動が契機となった可能性が高いと考えられた．
A 72-year-old woman with bipolar disorder visited our department with a complaining of a persistent stinging pain in the right cheek, as well as a stabbing pain in the right cheek and maxilla when brushing her teeth or drinking water. We diagnosed her as having right trigeminal neuralgia and immediately began administration of 300 mg/day carbamazepine. Because of similarities between the patient's psychiatric symptoms and the side effects of the antinociceptive drugs used to treat trigeminal neuralgia, selecting appropriate drugs or determineing their efficacy was difficult. Although the patient had strong resistance to and mental rejection of trigeminal nerve block, considering it a last-treatment option, she eventually consented to undergo alcohol nerve block, which improved her symptoms significantly.