Postdural puncture headache and pregabalin

Abstract

Background:Even if carried out under optimal conditions, postdural puncture headache is still a frustrating and unpleasant complication in spinal anesthesia. This syndrome has an estimated incidence from less than 1% to about 5% of patients undergoing spinal anesthesia, even in the highest risk subset, the young, female, and pregnant population.Case presentation:In our two female cases, headaches started following spinal anesthesia on the 11th and 14th hours, respectively. No response was obtained from patients diagnosed with postdural puncture headache with classical treatments such as bed rest, hydration, oral analgesic, and caffeine combination as well as intravenous theophylline application. The treatment of oral pregablin, commonly used for cases that rejected epidural blood patch, caused a significant decrease in headache severity. Later, the two cases whose headaches were completely resolved were discharged from the hospital on the post-operative 7th day.Conclusion:Postdural puncture headache is one of the most common complications of spinal anesthesia. Cerebral spinal fluid leakage into the epidural space has been proposed as the main mechanism responsible for this syndrome. Multiple methods of treatment have been applied with wide-ranging results. We detected that oral pregabalin application caused a significant decrease in the difficult and severe postdural puncture headaches of both our cases who did not respond to conventional treatments.

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

“…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 .…”

“…The patients in the treatment group had significantly lower pain analog scores ( P < .05) over the course of all 4 days and reported essentially no pain on days 3 and 4 of treatment. Zencirci et al reported 2 patients who improved on pregabalin 50 mg every 8 hours over a course of 3 days 72 . Hakim et al administered oral methergine 0.25 mg 3 times a day and 10 mg of oral metoclorpramide twice a day for 48 hours to 25 obstetric patients with complete resolution of symptoms in 24 of 25 patients by day 3 73 .…”

“…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.…”

Midazolam in Spinal Anesthesia — Intrathecal or Intravenous?

“…The first spinal anesthesia was carried out by Dr August Bier in 1899 and his anesthetic technique has become the standard practice for lower extremity and abdominal surgery worldwide [1]. Nowadays, the most commonly used drugs for spinal anesthesia are local anesthetics.…”

Effect of Pre and Post Nursing Intervention on the Occurrence of Tension Headache among Surgical Patients Undergoing Spinal Anesthesia

“…It develops in 16% to 86% of the cases after attempted spinal block with large bore needles [2]. It is described as frontal or occipital pressure occurring in the upright position and decreasing or resolving when supine [3]. According to the International Tension Headache Society, the criteria for PDPH include a tension headache that develops less than seven days after a spinal puncture, occurs or worsens less than fifteen minutes after assuming the upright position, and improves less than thirty minutes in the recumbent position with at least one of the following symptoms: neck stiffness, tinnitus, hypacusia, photophobia, and nausea.…”