Drug therapy for treating post-dural puncture headache

Ona, Xavier Basurto; García, Laura Martínez; Solà, Iván; Cosp, Xavier Bonfill

doi:10.1002/14651858.cd007887.pub2

Cited by 33 publications

(20 citation statements)

References 46 publications

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“…3 While a randomised control trial (RCT) conducted in Egypt found that a single intravenous bolus of caffeine sodium benzoate reduced the incidence of PDPH in young patients undergoing knee surgery under spinal anaesthesia, 38 a Cochrane systematic review also found that both oral and intravenous caffeine were effective compared with placebo in reducing the proportion of patients with persistent PDPH and those needing additional conservative interventions. 39 • Sumatriptan: Sumatriptan is a triptan class of anti-migraine drugs and has been suggested for treatment of PDPH. However, sterile autologous blood into the epidural space at the same lumbar interspace where the dural puncture was performed initially (preferably not beyond two levels from the original site).…”

Section: Drug Therapymentioning

confidence: 99%

“…41 Although the small sample size in the Erol study and the case-series design in Wagner's study limit the generalisation of their findings, similar findings have been reported in two other studies. 39,43 • Dexamethasone and hydrocortisone: The mechanism of action of these glucocorticoids in the management of PDPH is unclear but the effects are thought to result from sodium and water retention. 13 Studies on the use of dexamethasone and hydrocortisone in the prevention of PDPH are inconclusive but most point in the direction of possible benefit.…”

mentioning

confidence: 99%

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Postdural puncture headache: evidence-based review for primary care

Omole

Ogunbanjo

2015

South African Family Practice

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The promotion of epidural and spinal blocks as preferred and safe techniques for Caesarean section and the use of lumbar puncture for diagnostic and therapeutic purposes place patients at risk of developing postdural puncture headache (PDPH). This article reviews the literature for evidence that provides an approach to diagnosis and management of this condition for the primary care physician. A dull and throbbing, bilateral headache associated with changes in posture (worsened by sitting and standing, and better lying down), that develops within seven days of a lumbar puncture or an inadvertent dural puncture must raise the suspicion of PDPH. The exact causative mechanism is unclear but symptoms of PDPH are generally attributed to excessive loss of cerebrospinal fluid (CSF). The risk of PDPH is increased with the use of cutting and large-bore needles, and with horizontal orientation of the needle bevel. Given that symptoms overlap, other organic causes of headache such as intracerebral/subdural haemorrhage, pneumocephalus, central nervous system infections, adverse effects of anticoagulants and functional headaches such as migraine must be excluded. Although the initial management of PDPH comprises several conservative interventions, evidence is only available for the effectiveness of the usage of caffeine, analgesics, gabapectin, hydrocortisone, dexamethasone and cosyntropin. Epidural blood patch (EDBP) offers the most favourable outcomes for patients who fail to respond to conservative management. However, given the lack of skills for performing EDBP in primary care, such patients should be referred to secondary or tertiary level of care.

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Section: Drug Therapymentioning

confidence: 99%

mentioning

confidence: 99%

Postdural puncture headache: evidence-based review for primary care

Omole

Ogunbanjo

2015

South African Family Practice

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“…4 Caffeine and gabapentin have been shown to improve symptoms and have minimal side effects. 10 Caffeine is hypothesised to act through the vasoconstriction of cerebral vessels. Spontaneous recovery usually occurs within five days, but can last for protracted periods.…”

Section: Discussionmentioning

confidence: 99%

Severe postpartum headache

Chee

Lau

2017

BMJ

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“…Caffeine, gabapentin, theophylline, and hydrocortisone have some efficacy in the treatment of such headache. 32 Epidural blood patch remains the mainstay of treatment; in a study of 504 patients, complete relief was noted in 75 percent, incomplete relief in 18 percent, and failure to relieve symptoms in only 7 percent. 33 If the initial blood patch does not relieve symptoms, a second blood patch should be administered, often with an extended period of lying supine following the procedure.…”

Section: Intracranial Hypotensionmentioning

confidence: 99%