BACKGROUND: Epidural blood patching (EBP) is the primary treatment for spontaneous intracranial hypotension (SIH), although multiple attempts may sometimes be necessary. The SIH-EBP score, with a cutoff of ≥3, predicts the response to the first EBP. However, its generalizability requires further confirmation. This study aims to validate the clinical utility of the SIH-EBP score and determine the optimal cutoff for predicting the response to the first EBP in an independent cohort of patients with SIH. METHODS: This retrospective study included patients with SIH who received at least one EBP at a tertiary medical center. Clinical data were extracted from electronic medical records, and brain and spinal magnetic resonance images were reviewed. RESULTS: Ninety-six patients (58 female [F]/38 male [M], mean age: 42.67 ± 10.16 years) were screened, with 49 (32 F/17 M, mean age: 41.20 ± 9.13 years) analyzed, including 30 (22 F/8 M, mean age: 41.10 ± 10.14 years) (61.2%) responders. There was a positive correlation between SIH-EBP scores and responder rates ( p = 0.001). A cutoff score of ≥3 was associated with a higher response rate than a score of <
3 (80.0% vs 41.7%, p = 0.006) (sensitivity = 73.7%, specificity = 66.7%, accuracy = 69.4%). The optimal cutoff in this cohort was ≥2 (Area under curve (AUC) = 0.77, p <
0.001) (sensitivity = 52.6%, specificity = 90.0%, accuracy = 75.5%). CONCLUSION: In this cohort, the SIH-EBP score correlated with response rates to the first EBP. Although a score of ≥3 remains a valid predictor of treatment response, a cutoff of ≥2 proved to be more accurate and specific. However, its practical use is limited by a sensitivity of 52.6%. Further studies are needed to verify its role in other populations.