Post-Epidural Headache: How Late Can It Occur?

Abstract

Background:Complications of labor epidural anesthesia include a post-dural puncture headache (PDPH). A 2003 meta-analysis described the onset of PDPH as occurring from 1 to 7 days after the procedure. Presented here is the first published case of a PDPH occurring 12 days postpartum.Methods: Twelve days after an uncomplicated labor epidural a patient was awakened by a "crushing" postural headache. The initial diagnosis was "possible subarachnoid hemorrhage." Lumbar puncture and computed tomography angiogram were normal. Despite medications a severe postural headache persisted and she was referred for an epidural blood patch. Consultants felt the headache onset after 7 days made PDPH impossible. Ultimately a delayed EBP was performed with immediate resolution of her headache.Discussion: Meta-analyses describe that parturients have a 1.5% risk of accidental dural puncture during epidural placement. Onset of the headache occurs as early as 1 or as late as 7 days after the procedure. Epidural blood patch is the most effective treatment for PDPH and a rapid response is diagnostic. Conclusion

Inadvertent epidural infusion of paracetamol in an elderly patient

“…The entire asymptomatic period of 24 hours observed here was inconsistent with a case study of an adolescent who had already started suffering from headaches and nausea within two hours of inadvertent paracetamol application [6]. The post-epidural headache most often occurs after 24-48 hours post punction [7].…”

Postdural puncture headache: evidence-based review for primary care

“…6 However, there are outstanding cases of PDPH developing and resolving outside of this time range: One reported by Lomax et al in which PDPH developed 20 minutes after dural puncture 7 and another by Reamy that presented 12 days post dural puncture. 8 While most PDPH resolve within 14 days, a case of PDPH that lasted 19 months after the dura puncture was reported by Wilton et al 9 Surprisingly, this headache was managed successfully with an epidural blood patch (EDBP) 19 months later.…”

Headache after dural puncture subarachnoid hemorrhage posing as meningitis

“…In literature, PDPH has been described to begin typically between days 1 and 7, though we also came across a report for onset of PDPH on day 12. 1 It is postulated that a potentially continual source of CSF leak leads to low CSF pressure with pulling on the dura and bridging veins, causing post dural puncture headache (PDPH). 2 If this headache is left untreated, the shearing forces can lead to venous tears and acute or chronic subdural hematomas.…”

“…1 This case discussion highlights an important diagnostic dilemma when dealing with an atypical headache after spinal anesthesia. Differential diagnosis of headache after dural puncture includes post dural puncture headache (PDPH), migraine, drug induced headache, meningitis as well as some rare complications like sub arachnoid hemorrhage, sinus thromboses etc.…”