Postpartum post-dural puncture headache: is your differential diagnosis complete?

Bleeker, Chris P.; Hendriks, I.M.; Booij, L.H.D.J.

doi:10.1093/bja/aeh198

Cited by 28 publications

(17 citation statements)

References 27 publications

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“…Low-pressure headaches may be associated with loss of cerebrospinal fluid following dural puncture. 6,7 Conservative approaches to the management of low-pressure headaches include regular oral analgesics, maintenance of adequate hydration, caffeine 4 and anti-migraine therapies. 5 Epidural blood patching can also be used with some success, 8 but with occasional serious complications.…”

Section: Discussionmentioning

confidence: 99%

Acupuncture in the management of post-partum headache following neuraxial analgesia

Sharma

Cheam

2009

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Acupuncture in the management of post-partum headache following neuraxial analgesia

Sharma

Cheam

2009

International Journal of Obstetric Anesthesia

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“…The symptoms of PDPH seem to result from the loss of cerebrospinal fluid volume that triggers secondary cerebral vasodilatation and traction on pain sensitive structures of the cerebral contents when assuming an upright position. The differential diagnosis of a PDPH includes nonspecific headache, migraine, cerebral vein thrombosis, sinusitis, meningitis, caffeine withdrawal headache, drug-induced headache, eclampsia, and intracerebral bleeding 2,[5][6][7] (Table 2). Evidence from the literature supports EBP with 15 to 25 mL of the patient's own blood as the most effective treatment for PDPH.…”

Section: 3mentioning

confidence: 99%

Post-Epidural Headache: How Late Can It Occur?

Reamy¹

2009

The Journal of the American Board of Family Medicine

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Background:Complications of labor epidural anesthesia include a post-dural puncture headache (PDPH). A 2003 meta-analysis described the onset of PDPH as occurring from 1 to 7 days after the procedure. Presented here is the first published case of a PDPH occurring 12 days postpartum.Methods: Twelve days after an uncomplicated labor epidural a patient was awakened by a "crushing" postural headache. The initial diagnosis was "possible subarachnoid hemorrhage." Lumbar puncture and computed tomography angiogram were normal. Despite medications a severe postural headache persisted and she was referred for an epidural blood patch. Consultants felt the headache onset after 7 days made PDPH impossible. Ultimately a delayed EBP was performed with immediate resolution of her headache.Discussion: Meta-analyses describe that parturients have a 1.5% risk of accidental dural puncture during epidural placement. Onset of the headache occurs as early as 1 or as late as 7 days after the procedure. Epidural blood patch is the most effective treatment for PDPH and a rapid response is diagnostic. Conclusion

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“…Last, but of great interest, there are reports of intracranial hemorrhage and subarachnoid hemorrhage following dural puncture (9)(10)(11)(12). It has been postulated that leakage of cerebrospinal fl uid can cause intracranial hypotension, increasing transmural pressure across the arterial and/or venous wall, facilitating rupture (13).…”

Section: Discussionmentioning

confidence: 99%

Diagnosing and Managing Peripartum Headache

Grant

Wang

Gelpi

et al. 2015

Baylor University Medical Center Proceedings

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A 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation presented with a postpartum headache following vaginal delivery complicated by an unintentional dural puncture for epidural analgesia. Due to the positional nature of the headache and its frontal and occipital origin, a postdural puncture headache was diagnosed. After failure of conservative treatment, an epidural blood patch was used, which offered immediate relief. However, shortly following the procedure, the parturient's neurological condition deteriorated due to an unrecognized intraparenchymal and subarachnoid hemorrhage requiring an emergent craniectomy. This case highlights the importance of diligence when evaluating and treating postpartum headache despite a classic presentation. F orty percent of postpartum women have headaches, most of which occur in the fi rst week. Most causes of postpartum headaches are relatively benign, including migraines and tension headaches. Studies have demonstrated that the weeks following childbirth, known as the puerperium, are a particularly vulnerable time period for development of headaches of a variety of primary and secondary headache disorders, mainly due to hormonal, physiological, procedural, and psychological factors (1). Th is case highlights that the diagnosis of postpartum headache should be evaluated carefully, and secondary causes, that are potentially life threatening, should fi rst be ruled out before diagnoses of common causes are postulated. CASE DESCRIPTIONA 38-year-old gravida 7 para 5 Hispanic woman at 36 weeks and 4 days gestation with no signifi cant past medical history requested epidural analgesia for pain relief during augmented labor. Th e fi rst attempt at epidural catheter placement was complicated by dural puncture with a 17-gauge epidural needle, confi rmed by free fl ow of cerebrospinal fl uid. Th e second attempt at epidural catheter placement was successful, and continuous lumbar epidural analgesia was achieved and remained eff ective throughout the uneventful vaginal delivery.On the second postpartum day, the patient began to complain of a frontal headache and a verbal pain score of 6 to 10/10 that worsened in the upright position. Th e patient was initially normotensive with no focal neurological defi cits, and

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Postpartum post-dural puncture headache: is your differential diagnosis complete?

Abstract: We describe a patient with an intracerebral haemorrhage following an accidental dural puncture during an attempted epidural for pain relief in labour. Anaesthetists need to include intracerebral haemorrhage in the differential diagnosis of post-dural puncture headache in the puerperium.

Cited by 28 publications

References 27 publications

Acupuncture in the management of post-partum headache following neuraxial analgesia

Acupuncture in the management of post-partum headache following neuraxial analgesia

Post-Epidural Headache: How Late Can It Occur?

Diagnosing and Managing Peripartum Headache

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