Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population

Ranganathan, Pavithra; Golfeiz, Chaim; Phelps, Amy L.; Singh, Sanminder; Shnol, Helen; Paul, Nicole; Attaallah, Ahmed F.; Vallejo, Manuel C.

doi:10.1016/j.jclinane.2014.07.008

Cited by 51 publications

(42 citation statements)

References 20 publications

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“…1,2 The author presents a report of a patient presenting with persistent headaches following accidental dural puncture and its successful management by greater occipital nerve treatment. It is generally accepted that PDPH is a self-limiting condition.…”

mentioning

confidence: 99%

Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Niraj

2018

Headache

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mentioning

confidence: 99%

Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Niraj

2018

Headache

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“…This included 74 accidental dural punctures. 9 The present series is the first prospective longterm evaluation of the incidence of persistent headache following an ADP. They found that 23% of patients with ADP reported persistent headache lasting 6 weeks when compared to 7.1% of women who underwent an uneventful epidural.…”

Section: Discussionmentioning

confidence: 93%

“…9,21,22 In this series, 23 patients received 1 or more EBP. There are some reports suggesting epidural blood patch to be a risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…1 Accidental dural puncture (ADP) is a well-recognized complication of the technique and over two thirds of these patients develop post dural puncture headache (PDPH). [4][5][6][7][8][9] In a retrospective series with a case control design, Webb et al found that 28% of patients who developed PDPH had chronic headache at 18 months when compared to 5% of the controls. However there is emerging evidence that PDPH following ADP can result in persistent headache.…”

Section: Introductionmentioning

confidence: 99%

“…However there is emerging evidence that PDPH following ADP can result in persistent headache. 9 One of the authors (GN) observed a subset of female patients presenting with persistent headache following an accidental dural puncture. 8 A subsequent retrospective study in over 300 parturients with a documented accidental dural puncture revealed an incidence of chronic headache of 34.9%.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

et al. 2018

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Objective The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16‐gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. Background Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self‐limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. Methods Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow‐up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. Results Over an 18‐month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow‐up. Of the 39 patients who completed follow‐up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre‐existing headache. Conclusion Post dural puncture headache from an accidental dural puncture can no longer be considered a self‐limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.

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Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Uppal,

Russell,

Sondekoppam

et al. 2023

JAMA Netw Open

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ImportancePostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures, such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis, and management of this condition is, however, currently lacking.ObjectiveTo fill the practice guidelines void and provide comprehensive information and patient-centric recommendations for preventing, diagnosing, and managing PDPH.Evidence ReviewWith input from committee members and stakeholders of 6 participating professional societies, 10 review questions that were deemed important for the prevention, diagnosis, and management of PDPH were developed. A literature search for each question was performed in MEDLINE on March 2, 2022. Additional relevant clinical trials, systematic reviews, and research studies published through March 2022 were also considered for practice guideline development and shared with collaborator groups. Each group submitted a structured narrative review along with recommendations that were rated according to the US Preventive Services Task Force grading of evidence. Collaborators were asked to vote anonymously on each recommendation using 2 rounds of a modified Delphi approach.FindingsAfter 2 rounds of electronic voting by a 21-member multidisciplinary collaborator team, 47 recommendations were generated to provide guidance on the risk factors for and the prevention, diagnosis, and management of PDPH, along with ratings for the strength and certainty of evidence. A 90% to 100% consensus was obtained for almost all recommendations. Several recommendations were rated as having moderate to low certainty. Opportunities for future research were identified.Conclusions and RelevanceResults of this consensus statement suggest that current approaches to the treatment and management of PDPH are not uniform due to the paucity of evidence. The practice guidelines, however, provide a framework for individual clinicians to assess PDPH risk, confirm the diagnosis, and adopt a systematic approach to its management.

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Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population

Cited by 51 publications

References 20 publications

Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

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