Post-dural (post-lumbar) puncture headache: Risk factors and clinical features

Abstract

In conclusion, 14/48 patients (29%) suffered none of the above-mentioned symptoms, indicating that a significant number of patients may suffer from PDPH in the absence of any symptoms apart from the headache itself. This suggests that a further analyses of existing studies should be made to determine if a criteria change may need consideration.

Post Dural Puncture Headache (PDPH) and Associated Factors after Spinal Anesthesia among Patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia

“…Post-dural puncture headache typically presents as a postural headache that worsens when a patient is in the upright position and lessens to some extent when a patient is in the recumbent position [1][2][3][4][5][6]. PDPH is believed to originate from persistent leakage of cerebrospinal fluid (CSF) greater than the cerebrospinal fluid production after lumbar puncture [3].…”

“…According to the diagnostic criteria of the International Headache Society (IHS) in 2004, the headache can appear up to the fifth day after puncture and disappears spontaneously within a week, or up to 48 hours after an epidural blood patch (EBP) and accompanied by neck stiffness, tinnitus, hypoacusia (partial loss of hearing), photophobia, and nausea [7]. Even though the IHS reported this, recent studies indicated the latency period to be within 3 days [4][5][6][8][9][10][11][12], and another study conducted in 2012 to evaluate the validity of the diagnostic criteria for Post-Dural puncture headache showed that some patients can suffer from PDPH in the absence of the associated symptoms [4].…”

“…Women, particularly during pregnancy, are considered at increased risk for PDPH [1,2,4]. High levels of estrogens in women can influence the tone of the cerebral vessels, thus increasing the vascular distension response to CSF hypotension [1][2][3][4].…”

“…The incidence of PDPH is highest in young individuals [1,2,4,5] and lean patients [1][2][3][4]. Women who are obese or morbidly obese may have a decreased incidence of PDPH as a result of the increased in intra-abdominal pressure which acts as an abdominal binder helping to seal the defect in the dura and decreasing the loss of CSF [1].…”

“…The incidence is significantly higher when large bore needles greater than 22 G than when smaller needles (<25 G) were used [1,2,4,5]. Although smaller diameter needle punctures used for spinal block decrease the risk of PDPH, these needles are technically difficult to use and are associated with a lower success rate in spinal anesthesia [1][2][3][4].…”