Postdural puncture headache

Kyung-Hwa Kwak, Kyung-Hwa Kwak

Abstract

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

Keywords: Epidural blood patch; Postdural puncture headache.

References

    1. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth. 2003;50:460–469.
    1. Collier CB. Complications of regional anesthesia. In: Birnbach DJ, Gatt SP, Datta S, editors. Textbook of Obstetric Anesthesia. New York: Churchill Livingstone; 2000. pp. 504–523.
    1. Webb CA, Weyker PD, Zhang L, Stanley S, Coyle DT, Tang T, et al. Unintentional dural puncture with a Tuohy needle increases risk of chronic headache. Anesth Analg. 2012;115:124–132.
    1. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91:718–729.
    1. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24(Suppl 1):9–160.
    1. Amorim JA, Gomes de, Valença MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012;32:916–923.
    1. Douglas MJ, Ward ME, Campbell DC, Bright SB, Merrick PM. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. Int J Obstet Anesth. 1997;6:220–223.
    1. Lybecker H, Møller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg. 1990;70:389–394.
    1. Lybecker H, Djernes M, Schmidt JF. Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand. 1995;39:605–612.
    1. Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth. 2005;52:971–977.
    1. Hammad T, DeDent A, Algahtani R, Alastal Y, Elmer L, Medhkour A, et al. Posterior Reversible Encephalopathy Syndrome Secondary to CSF Leak and Intracranial Hypotension: A Case Report and Literature Review. Case Rep Neurol Med. 2015;2015:538523.
    1. Pugliese S, Finocchi V, Borgia ML, Nania C, Della Vella B, Pierallini A, et al. Intracranial hypotension and PRES: case report. J Headache Pain. 2010;11:437–440.
    1. Shah R, Kubisz-Pudelko A, Reid J. Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis - a case report. Local Reg Anesth. 2014;7:1–4.
    1. Gómez-Ríos MÁ, Fernández-Goti MC. Pneumocephalus after inadvertent dural puncture during epidural anesthesia. Anesthesiology. 2013;118:444.
    1. Cuypers V, Van de Velde M, Devroe S. Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth. 2016;25:58–65.
    1. Lim G, Zorn JM, Dong YJ, DeRenzo JS, Waters JH. Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series. Reg Anesth Pain Med. 2016;41:628–631.
    1. Bleeker CP, Hendriks IM, Booij LH. Postpartum post-dural puncture headache: is your differential diagnosis complete. Br J Anaesth. 2004;93:461–464.
    1. Morewood GH. A rational approach to the cause, prevention and treatment of postdural puncture headache. CMAJ. 1993;149:1087–1093.
    1. Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440–442.
    1. Di Cianni S, Rossi M, Casati A, Cocco C, Fanelli G. Spinal anesthesia: an evergreen technique. Acta Biomed. 2008;79:9–17.
    1. Kuczkowski KM. Post-dural puncture headache in the obstetric patient: an old problem. New solutions. Minerva Anestesiol. 2004;70:823–830.
    1. Liu H, Kalarickal PL, Rosinia F. A case of paradoxical presentation of postural postdural puncture headache. J Clin Anesth. 2012;24:255–256.
    1. Stride PC, Cooper GM. Dural taps revisited. A 20-year survey from Birmingham Maternity Hospital. Anaesthesia. 1993;48:247–255.
    1. Angle P, Thompson D, Halpern S, Wilson DB. Second stage pushing correlates with headache after unintentional dural puncture in parturients. Can J Anaesth. 1999;46:861–866.
    1. Jabbari A, Alijanpour E, Mir M, BaniHashem N, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4:595–602.
    1. Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology. 1992;42:1884–1887.
    1. Faure E, Moreno R, Thisted R. Incidence of postdural puncture headache in morbidly obese parturients. Reg Anesth. 1994;19:361–363.
    1. Miu M, Paech MJ, Nathan E. The relationship between body mass index and post-dural puncture headache in obstetric patients. Int J Obstet Anesth. 2014;23:371–375.
    1. Peralta F, Higgins N, Lange E, Wong CA, McCarthy RJ. The relationship of body mass index with the incidence of postdural puncture headache in parturients. Anesth Analg. 2015;121:451–456.
    1. Dodge HS, Ekhator NN, Jefferson-Wilson L, Fischer M, Jansen I, Horn PS, et al. Cigarette smokers have reduced risk for post-dural puncture headache. Pain Physician. 2013;16:E25–E30.
    1. Schmittner MD, Terboven T, Dluzak M, Janke A, Limmer ME, Weiss C, et al. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Int J Colorectal Dis. 2010;25:775–781.
    1. Gisore E, Mung'ayi V, Sharif T. Incidence of post dural puncture headache following caesarean section under spinal anaesthesia at the Aga Khan University Hospital, Nairobi. East Afr Med J. 2010;87:227–230.
    1. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006;82:713–716.
    1. Flaatten H, Rodt SA, Vamnes J, Rosland J, Wisborg T, Koller ME. Postdural puncture headache. A comparison between 26- and 29-gauge needles in young patients. Anaesthesia. 1989;44:147–149.
    1. Kuczkowski KM, Eisenmann UB. Hypertensive encephalopathy mimicking postdural puncture headache in a parturient beyond the edge of reproductive age. Anesth Analg. 2004;99:1873–1874.
    1. Richman JM, Joe EM, Cohen SR, Rowlingson AJ, Michaels RK, Jeffries MA, et al. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist. 2006;12:224–228.
    1. Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after inadvertent dural puncture. Anesthesiology. 1989;70:729–731.
    1. Oedit R, van Kooten F, Bakker SL, Dippel DW. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomised, observer-blind, controlled clinical trial [ISRCTN 71598245] BMC Neurol. 2005;5:12.
    1. Baysinger CL, Pope JE, Lockhart EM, Mercaldo ND. The management of accidental dural puncture and postdural puncture headache: a North American survey. J Clin Anesth. 2011;23:349–360.
    1. Arevalo-Rodriguez I, Ciapponi A, Roqué i, Muñoz L, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2016;3:CD009199.
    1. Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI, Crum BA, et al. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist. 2007;13:323–327.
    1. Al-metwalli RR. Epidural morphine injections for prevention of post dural puncture headache. Anaesthesia. 2008;63:847–850.
    1. Hakim SM. Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture. Anesthesiology. 2010;113:413–420.
    1. Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010;105:255–263.
    1. Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2013;57:417–430.
    1. Stein MH, Cohen S, Mohiuddin MA, Dombrovskiy V, Lowenwirt I. Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture--a randomised controlled trial. Anaesthesia. 2014;69:320–326.
    1. Tobias MD, Pilla MA, Rogers C, Jobes DR. Lidocaine inhibits blood coagulation: implications for epidural blood patch. Anesth Analg. 1996;82:766–769.
    1. Leivers D. Total spinal anesthesia following early prophylactic epidural blood patch. Anesthesiology. 1990;73:1287–1289.
    1. Strupp M, Brandt T, Müller A. Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol. 1998;245:589–592.
    1. Russell IF. A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia after accidental dural puncture in labour. Int J Obstet Anesth. 2012;21:7–16.
    1. Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol. 2006;19:249–253.
    1. Bezov D, Ashina S, Lipton R. Post-dural puncture headache: Part II--prevention, management, and prognosis. Headache. 2010;50:1482–1498.
    1. Heesen M, Klöhr S, Rossaint R, Walters M, Straube S, van de Velde M. Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis. Int J Obstet Anesth. 2013;22:26–30.
    1. Bolden N, Gebre E. Accidental dural puncture management: 10-year experience at an academic tertiary care center. Reg Anesth Pain Med. 2016;41:169–174.
    1. Bevacqua BK, Slucky AV, Cleary WF. Is postoperative intrathecal catheter use associated with central nervous system infection? Anesthesiology. 1994;80:1234–1240.
    1. Moore JM. Continuous spinal anesthesia. Am J Ther. 2009;16:289–294.
    1. Rigler ML, Drasner K, Krejcie TC, Yelich SJ, Scholnick FT, DeFontes J, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72:275–281.
    1. Berger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth. 1998;45:110–114.
    1. Straube A, Neudert C, Glas M, Brüning R, Padovan CS. The so-called spontaneous low CSF pressure pressure syndrome Case results indicating a disturbance in CSF/blood volume regulation. Nervenarzt. 2004;75:1194–1199.
    1. Mathew RJ, Wilson WH. Caffeine induced changes in cerebral circulation. Stroke. 1985;16:814–817.
    1. Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990;70:181–184.
    1. Yücel A, Ozyalçin S, Talu GK, Yücel EC, Erdine S. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med. 1999;24:51–54.
    1. Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;(7):CD007887.
    1. Mahoori A, Hassani E, Noroozinia H, Javaheri N, Hatami S. Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH) Middle East J Anaesthesiol. 2013;22:289–292.
    1. Ergün U, Say B, Ozer G, Tunc T, Sen M, Tüfekcioglu S, et al. Intravenous theophylline decreases post-dural puncture headaches. J Clin Neurosci. 2008;15:1102–1104.
    1. Beal B, Moeller-Bertram T, Schilling JM, Wallace MS. Gabapentin for once-daily treatment of post-herpetic neuralgia: a review. Clin Interv Aging. 2012;7:249–255.
    1. Erol DD. The analgesic and antiemetic efficacy of gabapentin or ergotamine/caffeine for the treatment of postdural puncture headache. Adv Med Sci. 2011;56:25–29.
    1. Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Saudi J Anaesth. 2014;8:374–377.
    1. Carp H, Singh PJ, Vadhera R, Jayaram A. Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. Anesth Analg. 1994;79:180–182.
    1. Connelly NR, Parker RK, Rahimi A, Gibson CS. Sumatriptan in patients with postdural puncture headache. Headache. 2000;40:316–319.
    1. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103:645–653.
    1. Paech MJ, Doherty DA, Christmas T, Wong CA. The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg. 2011;113:126–133.
    1. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep. 2015;64:1–65.
    1. Taivainen T, Pitkänen M, Tuominen M, Rosenberg PH. Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand. 1993;37:702–705.
    1. van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry. 2008;79:553–558.
    1. Beards SC, Jackson A, Griffiths AG, Horsman EL. Magnetic resonance imaging of extradural blood patches: appearances from 30 min to 18 h. Br J Anaesth. 1993;71:182–188.
    1. Carrie LE. Epidural blood patch: why the rapid response. Anesth Analg. 1991;72:129–130.
    1. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50:1144–1152.
    1. Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95:334–339.
    1. Sachs A, Smiley R. Post-dural puncture headache: the worst common complication in obstetric anesthesia. Semin Perinatol. 2014;38:386–394.
    1. Booth JL, Pan PH, Thomas JA, Harris LC, D'Angelo R. A retrospective review of an epidural blood patch database: the incidence of epidural blood patch associated with obstetric neuraxial anesthetic techniques and the effect of blood volume on efficacy. Int J Obstet Anesth. 2016 [Epub ahead of print]
    1. Reynvoet ME, Cosaert PA, Desmet MF, Plasschaert SM. Epidural dextran 40 patch for postdural puncture headache. Anaesthesia. 1997;52:886–888.
    1. Bel I, Moreno LA, Gomar C. Epidural dextran-40 and paramethasone injection for treatment of spontaneous intracranial hypotension. Can J Anaesth. 2006;53:591–594.
    1. Sun S, Huang SQ. Epidural injection of hydroxyethyl starch in the management of post-dural puncture headache: a case series. Int J Clin Exp Med. 2015;8:8254–8258.
    1. Niraj G, Kelkar A, Girotra V. Greater occipital nerve block for postdural puncture headache (PDPH): a prospective audit of a modified guideline for the management of PDPH and review of the literature. J Clin Anesth. 2014;26:539–544.
    1. Uyar Türkyilmaz E, Camgöz Eryilmaz N, Aydin Güzey N, Moraloğlu Ö. Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations. Braz J Anesthesiol. 2016;66:445–450.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner