Chronic headaches related to post-dural puncture headaches: a scoping review

Zhang, Qianpian; Pang, Sing Y.; Liu, Christopher Weiyang

doi:10.1016/j.bja.2022.08.004

Cited by 10 publications

(4 citation statements)

References 47 publications

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“…Despite being the current gold standard treatment for PDPH, a prospective, international cohort study of 643 women receiving EBP found that 28% of EBP failed, and around one-fifth of women required a second blood patch [11]. Whether EBP reduces the risk of longer-term sequelae such as chronic headache or backache is unclear, and our understanding of the physiology surrounding these processes remains incomplete [9 ▪▪ ,14]. Guidance emphasizes the need for adequate postprocedural information to both the patient and their primary care physician, as well as the importance of ensuring anaesthetic-led follow-up until the point at which the headache has resolved [7 ▪▪ ].…”

Section: Medium-longer-term Maternal Effects Of Neuraxial Analgesia I...mentioning

confidence: 99%

Long-term effects of neuraxial analgesia

Kearns,

Broom,

Lucas

2024

Current Opinion in Anaesthesiology

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Purpose of review This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. Recent findings Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve. For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. Summary Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.

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Section: Medium-longer-term Maternal Effects Of Neuraxial Analgesia I...mentioning

confidence: 99%

Long-term effects of neuraxial analgesia

Kearns,

Broom,

Lucas

2024

Current Opinion in Anaesthesiology

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“…Several recent retrospective studies have found a correlation between ADP and the development of chronic medical issues. ADP appears to increase the risk of a patient developing chronic headache, chronic backache, and chronic hearing issues [3,12,69,[73][74][75][76][77][78]79 && ,80]. The mechanism behind this development of chronic pain and neurologic complications is unknown.…”

Section: Postdural Puncture Sequelamentioning

confidence: 99%

Etiology, management, and sequela of postdural puncture headache

Taraskiewicz

Sheeran

Marco

et al. 2023

Current Opinion in Anaesthesiology

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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.

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“…Consequently, many patients often undergo multiple examinations over an extended duration until a definitive diagnosis is established [ 14 ]. While specific data on pPDPH is limited to case studies [ 15 ], research into Spontaneous Intracranial Hypotension (SIH) indicates that delays in treatment can adversely affect recovery chances [ 16 , 17 ]. In particular, early treatment within 12 weeks is associated with better outcomes [ 18 ] highlighting the critical importance of rapid diagnosis and intervention in conditions with similar symptomatology to PDPH, like SIH.…”

Section: Introductionmentioning

confidence: 99%

“…In the realm of medical research concerning PDPH, there is a recognized need for a comprehensive examination of its persistent form, pPDPH, and the diverse symptoms that may accompany this condition [ 15 ]. Surprisingly, despite the incidence of persistent headaches in accidental dural puncture patients being as high as 38%, these cases are seldom seen in pain clinics [ 10 , 12 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life, work ability and disability among individuals with persistent post-dural puncture headache

Kapan,

Waldhör,

Schiffler

et al. 2024

J Headache Pain

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Background and objectives Postdural puncture headache (PDPH) is an acknowledged consequence of procedures like lumbar punctures, epidural analgesia, and neurosurgical interventions. Persistence over more than three months, however has been poorly studied. In particular, little is known about the impact of persistent PDPH (pPDPH) on health related quality of life (HRQoL), disability and ability to work. The study aimed to provide a holistic understanding of pPDPH, encompassing medical, physical and psychological aspects. Methods We conducted a cross-sectional anonymous online survey in individuals aged 18 or older, diagnosed with, or suspected to have pPDPH via self-help groups on Facebook. Participants completed a structured questionnaire covering diagnosis, symptoms, and the ability to work. For assessing headache related disability, and mental health, they filled in the Henry Ford Hospital Headache Disability Inventory (HDI) and the Depression Anxiety Stress Scale-21 (DASS-21). Results A total of 179 participants (83.2% female, mean age 39.7 years) completed the survey. PPDPH had been present for one year or more in 74.3%, and 44.1% were unable to be in an upright position for more than one hour per day without having to lie down or sit down. Headaches were extremely severe or severe in 18% and 34%, respectively. According to the HDI, 31.8% of participants had mild, 25.7% moderate, and 42.5% severe disability. DASS-21 revealed substantial mental health challenges with depression, anxiety and stress experienced by 83%, 98%, and 88% of the respondents. The ability to work was limited considerably: 27.9% were unable to work, 59.8% worked part-time, 1.1% changed their job because of pPDPH, and only 11.2% were able to work full-time in their previous job. Despite treatment, the patients’ condition had deteriorated in 32.4% and remained unchanged in 27.9%. Conclusion This study stresses the burden of pPDPH in terms of substantial disability, limited quality of life, mental health concerns, and significant impact on the ability to work. The study highlights the long-term impact of pPDPH on individuals, emphasizing the need for timely diagnosis and effective treatment. It underscores the complexity of managing pPDPH and calls for further research into its long-term effects on patient health and HRQoL.

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Chronic headaches related to post-dural puncture headaches: a scoping review

Cited by 10 publications

References 47 publications

Long-term effects of neuraxial analgesia

Long-term effects of neuraxial analgesia

Etiology, management, and sequela of postdural puncture headache

Health-related quality of life, work ability and disability among individuals with persistent post-dural puncture headache

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