Introduction:Intracranial subdural hematoma formation has been observed following significant CSF drainage. Headache caused by CSF leakage is commonly effective treated with epidural blood patch. Subdural hematoma is usually treated with neurosurgical approach. We report a case of headache due to subdural hematoma associated with spontanous CSF leakage, which was effectively treated by epidural blood patch. METHODS: Retrospective review of the patient's medical record and head CT, total spine myelogram, MRI imaging. CASE REVIEW:A 45-year-old woman with 6 weeks history of headache. A head CT revealed subacute intracranial subdural hematoma. The patient was anesthetized for SDH drainage in OR. But the surgery was abruptly called off by the neurosurgeon. A followup CT Myelogram of total spine demonstrated CSF leakage in thoracic and cervical spine. Pain service was consulted and performed a lumbar epidural blood patch with 100% resolution of her headache. 5 months followup was negative for any neurological sequale and recurrent headache. CONCLUSIONS: A detailed medical history revealed the patient had classic positional headache for one week. Such headache is often associated with CSF leakage. However,initial neurological evaluation diagnosed her as subdural hematoma. Intracranial hypotention induced by CSF leakage may contribute to incranial hemorrhage, i.e.subdural hematoma.The etiology of the headache in our case is from CSF leakage.Although the leakage was in the thoracic & cervical spine region, lumbar epidural blood patch is an effective treatment method for such headache.