Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms: An analysis of 75 consecutive patients with PDPH

Lybecker, H; Djernes, M; Schmidt, J. F.

doi:10.1111/j.1399-6576.1995.tb04135.x

Cited by 158 publications

(114 citation statements)

References 36 publications

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“…Future studies should use established and well-defined criteria for PLPHA and its severity. 8,9 Methods. A literature search conducted by one of the authors (R.W.E.)…”

mentioning

confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

246

136

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Headache (HA) is a common sequel to lumbar puncture (LP), whether performed for diagnosis or anesthesia. [1][2][3][4][5][6] In their monograph summarizing the world literature through 1960, Tourtellotte et al.1 considered separately three principal patient populations: 1) patients undergoing diagnostic LPs (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA; 2) patients undergoing nonobstetric spinal anesthesia; and 3) patients undergoing obstetric spinal anesthesia. They reported several observations.1. The average frequency of post-LP HAs (PLPHA) in patients after diagnostic LP (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA, was 32%. For nonobstetric spinal anesthesia, the average frequency was 13%. For obstetric spinal anesthesia, the average frequency was 18%. 2. In reports in which patients received special measures to prevent PLPHA, the average frequencies were 6% for diagnostic LPs, 5.5% for nonobstetric spinal anesthesia, and 6.2% for obstetric spinal anesthesia. The actual frequencies in individual series ranged from 0 to 18%. 3. The frequency of PLPHA was 36% in their own series of 105 normal individuals, 30% in 317 patients with diagnostic LPs, and 2% definite and 2% probable in 100 patients undergoing spinal anesthesia (but 30 patients with HAs of other types were excluded from the latter count).In analyzing risk factors for PLPHA, they concluded that the evidence, including their own prospective series, was convincing to consider younger age and female gender as definite risk factors. They attributed the difference of PLPHAs in obstetric and nonobstetric patients undergoing spinal anesthesia at least in part to these factors. They further considered the data fairly convincing that the smaller the needle size, the lower the frequency of PLPHA, but were unable to show this in their prospective series. They commented that the great variability of HA frequency for the same needle size between authors may reduce the reliability of this observation. With regard to all other risk factors, they concluded that the evidence was inconclusive. With regard to all preventive or therapeutic measures, they commented that proponents of a particular treatment, in general, found it to be beneficial; however, some of the reports were uncontrolled and some results could not be replicated by others. Today, we would consider the latter findings a result of publication bias-if one first tried a new approach to reducing the incidence of PLPHA, one would be less likely to publish a failure than a success.They commented on the different frequency of PLPHA in patients undergoing diagnostic LP compared with those undergoing spinal anesthesia, and considered the following factors in their series: age, gender, needle size, fasting, hydration, premedication and postoperative medication, minimal amount of trauma to the meninge...

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“…Future studies should use established and well-defined criteria for PLPHA and its severity. 8,9 Methods. A literature search conducted by one of the authors (R.W.E.)…”

mentioning

confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

246

136

View full text Add to dashboard Cite

show abstract

“…Hypotension can cause veno-dilation in cerebral space and this venodilatation may be directly the cause of headache. Some other symptoms can accompany this situation as nausea, vomiting, visual disturbances, and hearing alteration [7,9,10].…”

Section: Discussionmentioning

confidence: 99%

The Rate and Severity of Headache after Caesarean Section under Spinal Anaesthesia are decreased by Hypertonic Solutions: A Randomized Placebo-Controlled Clinical Trial

Khooshideh¹,

Shahriari²,

Bitarafan³

2017

Int J Neurorehabilitation Eng

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“…22 Lower incidence of PDPH were reported by Lybecker et al, Agarwal et al, Almeida et al and Myers et al The incidence of PDPH in their studies were 7.35 %, 5.9 %, 5.6 % and 0.3 % respectively. [23][24][25][26] In our study 23, 25 and 26 gauge spinal needles were used in 37, 141 and 22 patients respectively. 9 patients (24.3 %) complained of headache with 23 gauge needle, 13 patients (9.2 %) with 25 gauge needle and 1 patient (4.5 %) with 26 gauge needle during post operative period.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Post Dural Puncture Headache in Spinal Anaesthesia for Cholecystectomy

Fatimah¹,

Haq²,

Hilal³

et al. 2014

J Pharm Sci Innov.

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Post dural puncture headache is a significant and well known complication of puncture of the duramater. Historical reference to Post dural puncture headache was recorded by August Bier in 1899. There is a direct correlation between needle size and risk of Post dural puncture headache. This study comprised of 200 ASA grade I and II patients between 15 to 74 years of age of both sexes who underwent elective cholecystectomy. After undergoing a thorough preanaesthetic check up each patient received pre-medication one night before surgery and skin sensitivity test was done. Patient was kept nil orally, a baseline pulse rate, blood pressure and oxygen saturation were recorded. Lumbar puncture was done in sitting position at L2-L3 inter vertebral space with Quincke needle (23, 25, 26 G). After assuring a free flow of clear cerebrospinal fluid 4 ml of 0.5 % bupivacaine heavy was injected. After achieving satisfactory block patients were oxygenated by face mask and regular monitoring of pulse rate, blood pressure and oxygen saturation was done and recorded. Statistical analyses was done by applying students 't' test. The mean age of the patient was 41.2 ± 12.2 years and female patients outnumbered their male counterparts (87.5 %). 25G needle was used in maximum number of patients. The incidence of Post dural puncture headache with 23, 25, 26 G was 24.3 %, 9.2 %, 4.1 % respectively. On statistical analysis the Post dural puncture headache was significantly higher with 23G needle as compared to 25 or 26G (p < 0.05). However there is no statistical significance between 25 and 26G needles. The study concluded that the incidence of post dural puncture headache can be reduced to minimum with the use of small sized needles and proper technique of spinal anaesthesia by an experienced anaesthesiologist.

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Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms: An analysis of 75 consecutive patients with PDPH

Cited by 158 publications

References 36 publications

Assessment: Prevention of post–lumbar puncture headaches

Assessment: Prevention of post–lumbar puncture headaches

The Rate and Severity of Headache after Caesarean Section under Spinal Anaesthesia are decreased by Hypertonic Solutions: A Randomized Placebo-Controlled Clinical Trial

Incidence of Post Dural Puncture Headache in Spinal Anaesthesia for Cholecystectomy

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