Postpartum Headache

Salahuddin

et al. 2016

NSJ

Postpartum headache is described as headache and neck or shoulder pain during the first 6 weeks after delivery. Common causes of headache in the puerperium are migraine headache and tension headache; other causes include pre-eclampsia/eclampsia, post-dural puncture headache, cortical vein thrombosis, subarachnoid hemorrhage, posterior reversible leukoencephalopathy syndrome, brain tumor, cerebral ischemia, meningitis, and so forth. Idiopathic intracranial hypertension (IIH) is a rare cause of postpartum headache. It is usually associated with papilledema, headache, and elevated intracranial pressure without any focal neurologic abnormality in an otherwise healthy person. It is more commonly seen in obese women of reproductive age group, but rare during pregnancy and postpartum. We present a case of IIH who presented to us 18 days after cesarean section with severe headache and was successfully managed.

Section: Discussionmentioning

confidence: 99%

“…Postpartum headache (PH) is described as headache with or without neck or shoulder pain experienced during the first 6 weeks after delivery 1. Postpartum headache has a reported incidence of 39% in the first week of postpartum,2 and the most common cause is pre-existing primary headache, such as migraine or tension headache with transient exacerbation.…”

mentioning

confidence: 99%

Idiopathic intracranial hypertension presenting as postpartum headache

Salahuddin

et al. 2016

NSJ

Acta Anaesthesiologica Scandinavica

“…There are clearly some risks associated with performing an EBP. Several case reports are presented in the literature with documented major complications ranging from infection or partial nerve damage to epidural haematomas and paraperesis 12 . These risks have to be weighed against the risks of major complications associated with expectant management such as subdural haematoma 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Different techniques and medications have been attempted for the treatment of PDPH 8–10 but the one remedy with the greatest and quickest success is the use of the epidural blood patch (EBP) 11 . Although effective in a majority of cases in different epidemiological trials and considered as standard practice, EBP has been associated with uncommon, serious complications in several case reports 12 . Therefore, many physicians prefer conservative management of PDPH before resorting to more invasive methods such as EBP.…”

mentioning

confidence: 99%

Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey

Darvish

Gupta

Alahuhta

et al. 2010

International Journal of Obstetric Anesthesia

“…While blindness is a very rare complication of epidural procedures, it has been reported after epidural steroid 18 and local anesthetic injection, 19,20 and even after the injection of 30 mL of saline to treat a dural puncture. 21 Routine measurement of the epidural pressure during EBP might have a clinical advantage by helping to avoid the generation of excessively high pressure that may occur even at relatively low volumes, and thus may prevent the consequent complications associated with rapid increases in CSF pressure described above.…”

Section: Discussionmentioning

confidence: 99%

Observational study of changes in epidural pressure and elastance during epidural blood patch in obstetric patients

Pratt

Kaczka

Hess

2014

Background During an epidural blood patch, we inject blood until the patient describes mild back pressure, often leading to injection of more than 20 mL of blood. We undertook this study to measure the epidural pressures generated during an epidural blood patch and to identify the impact of volume on epidural elastance in obstetric patients. Methods This study was performed in postpartum patients who presented for an epidural blood patch with symptoms consistent with a postdural puncture headache. After identification of the epidural space using loss of resistance to air or saline, we measured static epidural pressure after each 5-mL injection of blood. Models were then fitted to the data and the epidural elastance and compliance calculated. Results Eighteen blood patches were performed on 17 patients. The mean final volume injected was 18.9 ± 7.8 mL [range 6 to 38 mL]. The mean final pressure generated was 13.1 ± 13.4 mmHg [range 2 to 56 mmHg]. A curvilinear relationship existed between volume injected and pressure, which was described by two models: (1) pressure = 0.0254 × (mL injected)2 + 0.0297 × mL, or (2) pressure = 0.0679 × mL1.742. The value for r2 was approximately 0.57 for both models. We found no correlation between the final pressure generated and the success of the EBP. Conclusions We found a curvilinear relationship between the volume of blood injected during an epidural blood patch and the pressure generated in the epidural space. However, there was a large variation in both the volume of blood and the epidural pressure generated. The clinical importance of this finding is not known. A larger study would be required to demonstrate whether pressure is a predictor of success.