Postdural puncture headache

Abstract

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

Effect of Low-Dose Intravenous Ketamine on Prevention of Headache After Spinal Anesthesia in Patients Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial Study

“…It has been nearly a century since the introduction of the headache following the puncture of dura mater. However, this complication is still one of the most prominent factors limiting the use of spinal anesthesia (15). According to the findings of the present study, the mean of headache in the case and control groups were significantly different immediately and four hours after surgery.…”

Post-dural puncture headache incidence after cerebrospinal fluid aspiration. A prospective observational study

“…These findings have the potential to explain the opposite direction of our findings. Several studies report increased incidence of PDPH in younger patients, particularly females 35,36 . We found similar trends in our study, however sex did not show to play a role.…”

Experiencia clínica con la implantación de un protocolo multidisciplinar de cefalea postpunción dural

“…La prevención de la CPPD debe ser el objetivo principal de los clínicos. De hecho, la atención adecuada a los factores relacionados con el procedimiento puede reducir su incidencia (2).…”

“…A pesar de que las medidas conservadoras profilácticas tras una PDA no tienen demostrada una alta eficacia, se debe esperar 24-48░h, ya que más del 85░% de las CPPD se resuelven en este tiempo (2). El reposo absoluto no se recomienda debido al alto riesgo de trombosis (8), aunque es inevitable en pacientes con cefalea moderadasevera por la incapacidad que propicia la CPPD.…”

“…El reposo absoluto no se recomienda debido al alto riesgo de trombosis (8), aunque es inevitable en pacientes con cefalea moderadasevera por la incapacidad que propicia la CPPD. Tampoco se recomienda la hidratación suplementaria (8), y el uso de cafeína es muy discutible (2,6). Una vez instaurada la CPPD, el único tratamiento que ha mostrado ser efectivo es el PHE (2,7).…”