Epidural blood patching for preventing and treating post-dural puncture headache

Boonmak, Polpun; Boonmak, Suhattaya

doi:10.1002/14651858.cd001791.pub3

Cited by 17 publications

(35 citation statements)

References 30 publications

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“…By far the most effective treatment once PLPHA has developed is epidural blood patching with a success rate of up to 98% [18,21]. Epidural patches are not routinely performed by neurologists (who often do diagnostic LP), however, at least in the UK, but rather by anaesthetists, which often results in delays due to the required coordination between medical disciplines.…”

Section: Discussionmentioning

confidence: 99%

Change practice now! Using atraumatic needles to prevent post lumbar puncture headache

Davis

Dobson

Kaninia

et al. 2013

Euro J of Neurology

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Section: Discussionmentioning

confidence: 99%

Change practice now! Using atraumatic needles to prevent post lumbar puncture headache

Davis

Dobson

Kaninia

et al. 2013

Euro J of Neurology

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“…Comments: A review of phase 2 studies assessing efficacy and safety of four monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway (ALD403 [eptinezumab], AMG334 [erenumab], LY2951742 [galcanezumab] and TEV48125 [fremanezumab]) was recently published. 1 Fremanezumab, a humanized monoclonal antibody against the CGRP molecule, was shown to be effective, safe, and well-tolerated as both monotherapy and recently add-on therapy in migraine prevention. 2,3 This article from Melo-Carrillo et al helps establish a potential mechanism of action for this agent.…”

Section: -Wade M Cooper Domentioning

confidence: 99%

“…Evidence of an acute-phase response-elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or both-is present in more than 90% and may be sufficient for diagnosis. 1 Others may require temporal artery biopsy or vascular imaging. Glucocorticoids remain the primary treatment.…”

mentioning

confidence: 99%

“…Yet, Bigal et al write that toxicological issues are typically more likely due to exaggerated pharmacology, not to off-target effects such as the liver toxicity prevalent with the CGRP-RAs. 1 Yet based on prior reading, off targeting remains a concern, with more for those that antagonize receptors (downstream cellular effects) than bind to ligands, although I can't find that reference now as it was read some time ago. CGRP mAbs are from three of the four classes of IgG, which possess several differences, most particularly that IgG1 (eptinezumab) and IgG4 (galcanezumab) cross the placenta, requiring attention to pregnancy as an issue, while IgG2 (erenumab, fremanezumab) and 3 (none) do not or possibly only minimally.…”

mentioning

confidence: 99%

“…Calcitonin gene-related peptide immunoreactivity has been detected in most of the neurons of the cerebral cortex, hippocampus, cerebellum, thalamus, hypothalamus, and brainstem nuclei, and receptor activity-modifying protein 1 and calcitonin receptor-like receptor immunoreactivity found almost exclusively in the neuronal processes in those locations. 1 Several agents directed against CGRP or its receptors have been shown to be effective in migraine trials. 2 Erenumab (previously AMG 334) is a fully human monoclonal antibody against the CGRP receptor that has been pharmacologically characterized and shown in a phase 2 trial to be effective in the prevention of episodic migraine.…”

mentioning

confidence: 99%

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Abstracts and Citations

Kaniecki¹,

Taylor²,

Cooper³

2017

Headache

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-Koops H, Spiera R, Unizony SH, Collinson N. Trial of tocilizumab in giant-cell arteritis. N Engl J Med. 2017;377:317-328 Background: Giant-cell arteritis commonly relapses when glucocorticoids are tapered, and the prolonged use of glucocorticoids is associated with side effects. The effect of the interleukin-6 receptor alpha inhibitor tocilizumab on the rates of relapse during glucocorticoid tapering was studied in patients with giant-cell arteritis.Methods: In this 1-year trial, we randomly assigned 251 patients, in a 2:1:1:1 ratio, to receive subcutaneous tocilizumab (at a dose of 162 mg) weekly or every other week, combined with a 26-week prednisone taper, or placebo combined with a prednisone taper over a period of either 26 weeks or 52 weeks. The primary outcome was the rate of sustained glucocorticoid-free remission at week 52 in each tocilizumab group as compared with the rate in the placebo group that underwent the 26-week prednisone taper. The key secondary outcome was the rate of remission in each tocilizumab group as compared with the placebo group that underwent the 52-week prednisone taper. Dosing of prednisone and safety were also assessed.

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Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section: A case report

Shrestha,

Chalise,

Poudel

et al. 2023

Clinical Case Reports

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Key Clinical messageNeostigmine and atropine offer a promising treatment option for postdural puncture headache (PDPH) following spinal anesthesia in cesarean section, providing effective relief with a favorable risk–benefit profile.AbstractPostdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31 years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non‐steroidal anti‐inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20 mcg/kg) along with atropine (10 mcg/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research.

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Epidural blood patching for preventing and treating post-dural puncture headache

Cited by 17 publications

References 30 publications

Change practice now! Using atraumatic needles to prevent post lumbar puncture headache

Change practice now! Using atraumatic needles to prevent post lumbar puncture headache

Abstracts and Citations

Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section: A case report

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