Intravenous theophylline rapidly decreases post-lumbar puncture headaches

Abstract

When managing therapy for the post-lumbar puncture headaches (PLPHs), an efficacious, fast-acting, practical and safe method is preferred. Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches. The aim of this study was to highlight the brief initial time for a remarkable decrease of PLPH pain levels after the administration of IV theophylline infusion. We observed that IV theophylline infusion has a rapid and marked effect on decreasing pain in PLPHs. At 30 min of theophylline infusion, mean VAS levels were decreased by 47.1 % and at 60 min of infusion, the decrease of pain was 61.9 %. We conclude that IV theophylline infusion is a rapidly effective, noninvasive, practical and low-cost way to treat PLPHs. To the best of our knowledge, this is the first study to highlight both the efficacy and the speed of the effect of pain relief in PLPHs.

Magnetic resonance imaging findings and clinical management of suspected intracranial hypovolemia after transfrontal craniotomy in a dog

“…8,22 Action mechanisms of theophylline are not completely understood, 25 but it is thought to improve IH by inhibition of the compensatory vasodilatation by means of a dose dependent effect, which could also explain the effectiveness of other vasoconstrictive drugs such as caffeine. 24 The dog described in our case report experienced a remarkable improvement with medical treatment; however, the authors suspect that natural closure of dural defect helped decrease the amount of the suspected CSF loss. Because of the dog's gradual improvement with medical management, a second surgery to seal the neurocranium was not performed.…”

“…The initial medical treatment includes bed rest (flat posture), oral hydration, 9,12,22 head down and elevated feet posture (Trendelenburg position) 9 , caffeine, corticosteroids, 8,22 and theophylline. 22,24 If medical therapy is not successful, surgical repair of the CSF leak is then indicated. 8,22 Action mechanisms of theophylline are not completely understood, 25 but it is thought to improve IH by inhibition of the compensatory vasodilatation by means of a dose dependent effect, which could also explain the effectiveness of other vasoconstrictive drugs such as caffeine.…”

Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis

“…Thus, 21 potentially relevant articles were selected and examined in detail. Finally, six studies were excluded for one or more of the following reasons: non-RCT trial (n = 2) [18,19]; conference abstract, www.anesth-pain-med.org with no available data (n = 1) [20]; inappropriate data (n = 2) [21]; and use of aminophylline in combination with other components without a suitable control group (n = 1) [22]. After ultimate evaluation, 15 eligible studies (6 on therapeutic and 9 on prophylactic effects) met the inclusion criteria and were appropriate for inclusion in the final meta-analysis.…”

Is theophylline more effective than sumatriptan in the treatment of post-dural puncture headache? A randomized clinical trial

“…[11] Vascular expansion can be the main cause of PDPH. [12] Theophylline, a methylxanthine derivative, can reduce intracranial blood flow and venous enlargement [13] by two mechanisms: first; it interferes with calcium uptake by the sarcoplasmic reticulum, inhibits phosphodiesterase enzymes, and blocks adenosine receptors, which all result in cerebral vasoconstriction, second; it stimulates sodium/potassium pump in the choroid plexus, which increases CSF production. [14] Also, it may decrease the headache by blocking the transmission of pain perception.…”