Purpose The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. Recent findings There is emerging data about how modifiable risk factors for PDPH are not as absolute as once believed. There have been several new meta-analysis and clinical trials published, providing more data about effective therapies for PDPH. Significantly, much recent data has come out about the sequalae, particularly long-term of dural puncture. Summary Emerging evidence demonstrates that in patients who are at low risk of PDPH, needle type and gauge may be of no consequence in a patient developing a PDPH. Although epidural blood patch (EBP) remains the gold-standard of therapy, several other interventions, both medical and procedural, show promise and may obviate the need for EBP in patients with mild–moderate PDPH. Patients who endure dural puncture, especially accidental dural puncture (ADP) are at low but significant risk of developing short term issues as well as chronic pain symptoms.

BACKGROUND: Epidural blood patch (EBP) procedure timing can be difficult in patients on anticoagulant therapy when balancing the goals of EBP, safety, and efficacy. CASE REPORT: We present the case of a patient on anticoagulant therapy with low molecular weight heparin (LMWH) who presented for a planned cesarean section which was complicated by dural puncture with a Tuohy needle during combined spinal-epidural placement. She then developed a postdural puncture headache (PDPH) after restarting LMWH. After holding LMWH for 18 hours, an EBP was placed resulting in symptomatic relief; LMWH was restarted 12 hours later. However, her symptoms returned and EBP was repeated 78 hours after the initial blood patch, again with relief of symptoms. CONCLUSION: This case highlights the importance of EBP procedure timing in the setting of LMWH administration in order to maximize efficacy while minimizing neuraxial hematoma and venous thromboembolism risk. KEY WORDS: Epidural blood patch, postdural puncture headache, anticoagulation, efficacy, timing