Postdural puncture headache and ACTH

Gupta, Sunanda; Agrawal, Anita

doi:10.1016/s0952-8180(97)00042-1

Cited by 21 publications

(18 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One controlled trial found that sumatriptan was ineffective in treatment of PDPH 64 . There are also reports regarding successful use of adrenocorticotropic hormone (ACTH), mirtazapine, pregabalin, and trials of gabapentin, methergine, with metoclopramide and hydrocortisone in treatment of PDPH 65‐73 . Gupta et al reported complete relief in 40 of 48 patients after injection of 60 U of ACTH intramuscularly 65 .…”

Section: Approach To Treatmentmentioning

confidence: 99%

“…64 There are also reports regarding successful use of adrenocorticotropic hormone (ACTH), mirtazapine, pregabalin, and trials of gabapentin, methergine, with metoclopramide and hydrocortisone in treatment of PDPH. [65][66][67][68][69][70][71][72][73] Gupta et al reported complete relief in 40 of 48 patients after injection of 60 U of ACTH intramuscularly. 65 An additional 6 patients had complete relief 24 hours later after second injection with 1 patient reporting incomplete relief and 1 reporting recurrence of headache.…”

Section: Approach To Treatmentmentioning

confidence: 99%

“…[65][66][67][68][69][70][71][72][73] Gupta et al reported complete relief in 40 of 48 patients after injection of 60 U of ACTH intramuscularly. 65 An additional 6 patients had complete relief 24 hours later after second injection with 1 patient reporting incomplete relief and 1 reporting recurrence of headache. Collier et al reported complete headache relief in 14 of 20 patients with orthostatic headache after a dural puncture after an infusion of 1.5 u/kg of ACTH infused over 1 hour in 1-2 L of lactated Ringer's solution.…”

Section: Approach To Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Post‐Dural Puncture Headache: Part II – Prevention, Management, and Prognosis

2010

View full text Add to dashboard Cite

Post-dural puncture headache (PDPH) is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. As PDPH can be disabling, clinicians who perform these procedures should be familiar with strategies for preventing this disorder. Since the best preventative measures sometimes fail, clinicians should also be familiar with the therapeutic approaches for PDPH. Herein, we review the procedure-related risk factors for PDPH, the prognosis of PDPH and the studies of PDPH treatment. We divide the therapeutic approach to PDPH into 4 stages: conservative management, aggressive medical management, conventional invasive treatments, and the very rarely employed less conventional invasive treatments and provide management algorithm to facilitate treatment.

show abstract

Section: Approach To Treatmentmentioning

confidence: 99%

Section: Approach To Treatmentmentioning

confidence: 99%

Section: Approach To Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Post‐Dural Puncture Headache: Part II – Prevention, Management, and Prognosis

2010

View full text Add to dashboard Cite

show abstract

“…90% [3,30,33]. Ist der erste "blood patch" erfolglos, kann 60 U intramuskulär [14,31] [3,7]. Die Indikation für ACTH ist aufgrund seiner komplexen Wirkungsweise auf das hormonelle Gleichgewicht zurückhaltend zu stellen.…”

Section: Invasive Maßnahmenunclassified

Postpunktioneller Kopfschmerz

et al. 1999

View full text Add to dashboard Cite

Lumbar puncture (LP) is a routine technique performed for a variety of procedures, e.g. diagnosis, administration of drugs, myelography and spinal anaesthesia. Postdural puncture headache is a common complication (30-40% in diagnostic LP). Prevention can be accomplished by using small-gauge needles (< or = 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of analgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmacologic management have been presented in the literature, but most of these are case reports. There is a lack of large double-blind placebo-controlled studies. Theophylline, caffeine, ACTH and sumatriptan are potentially promising agents for the treatment of postdural puncture headache. The efficacy of theophylline has been proven in a double-blind and placebo-controlled study. There are a few studies and case reports reporting that caffeine p.o. and i.v. is effective in the treatment of postdural puncture headache, but recurrence of headache after caffeine therapy is frequent. ACTH acts on a complex hormonal system. The treatment with sumatriptan has been reported in only a few case reports. The third step, and one of the most effective treatments of postdural puncture headache, is the epidural blood patch. The success rate ranges between 80 and 97%.

show abstract

“…Why are some patients susceptible to this complication and others resistant? Why do certain remedies, including caffeine, [14][15][16][17] sumatriptan, 18,19 theophylline, 20 and adrenocorticotropin hormone 21,22 appear to help the condition when they do nothing to reduce the loss of CSF? Raskin 23 speculates that the sudden decrease in CSF volume that occurs after lumbar puncture activates adenosine receptors, thus producing venous and arterial vasodilation and the resulting syndrome of PDPH.…”

Section: Discussionmentioning

confidence: 99%