Gender and Post–Dural Puncture Headache

Wu, Christopher L.; Rowlingson, Andrew J.; Cohen, Seth R.; Michaels, Robert K.; Courpas, Genevieve E.; Joe, Emily M.; Liu, Spencer S.

doi:10.1097/00000542-200609000-00027

Cited by 88 publications

(81 citation statements)

References 47 publications

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“…5 Young men have also been shown to have lower risks of developing PDPH compared with young non-pregnant women (OR = 0.55; CI 0.44-0.67) but this disparity is lost among the elderly, among whom both sexes are equally susceptible. 15,30 In a retrospective study that assessed the influence of cigarette smoking on the risk of PDPH among patients who had continuous CSF sampling via catheter, cigarette smokers were found to have a lower incidence of PDPH compared with non-smokers (13.7% vs 34.1%; p = 0.009). 31 Although the mechanism is unclear, the authors proposed that the clot-promoting properties of smoking may facilitate the occlusion of the dural puncture by clot.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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: Patient Characteristicsmentioning

confidence: 99%

Postdural puncture headache: evidence-based review for primary care

Omole

Ogunbanjo

2015

South African Family Practice

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“…Another possible confounding factor taken into account in the present study is the history of chronic or recurrent tension headache, which has been claimed to be a risk factor for development of future tension headaches [16,19]. According to the current study, the duration of PDPH was longer among patients with a past history of recurrent tension headache, and past history of abdominal surgery.…”

Section: Discussionmentioning

confidence: 64%

“…Female sex is a debatable risk factor for PDPH [19] with some studies reporting a twofold risk among women and others denying any gender difference. Nonetheless, in the present research, the difference between patients in the study and control groups regarding the duration of PDPH remained in stratified analysis according to sex, which obviates any confounding effect of sex in the intervention study results.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pre and Post Nursing Intervention on the Occurrence of Tension Headache among Surgical Patients Undergoing Spinal Anesthesia

Ali¹

2012

J Anesth Clin Res

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Spinal anesthesia is a frequently performed procedure in medical emergencies and anesthesia. Tension headache after lumbar puncture is a common occurrence (32%) and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilize. The aim of this study is to assess the effect of pre and post nursing intervention on the occurrence of tension headache among surgical patients undergoing spinal anesthesia. This quasi-experimental study was conducted in El-Naser Health Insurance Hospital; in Helwan city in Egypt, 60 adult patients admitted for lower abdominal surgery using spinal anesthesia were recruited. The only exclusion criterion was pregnancy in female patients. Participants were alternatively assigned to either the intervention or control groups, ending with 30 patients in each group. The data collection tools consisted of two tools. Tool 1 was concerned with characterization of the pain and patient's personal data. The second tool was a visual analog scale (VAS). The researchers designed a structured pre-spinal anesthetic nursing intervention to be applied to the study group. Control group received the routine nursing intervention only. The results revealed that the incidence of tensions headache became significantly lower in the study group, reaching its lowest rate (3.3%) by the end of the third day, compared to 76.7% in the control group (p<0.001) the mean duration of tension headache was shorter in the study (22.1 ± 34.0 hours) than in the control (111.2 ± 55.9 hours) group, p<0.001 as well patients in the study and control groups also demonstrated statistically significant differences in the experience of symptoms associated with tension headache (p < 0.001). In conclusion, the structured nursing measures before and after the procedure was successful in decreasing the incidence and duration of this tension headache and its associated symptoms. Therefore, it is recommended to generalize these structured nursing measures in hospitals to be included in the routine pre-operative and post-operative nursing care for patients undergoing lower abdominal surgery with spinal anesthesia.

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“…14,15 We have patients lie in the recumbent position for approximately 30 minutes after the LP; however, this has not been shown to be effective in preventing postprocedural headache. 16 If the headache is still present Ն4 days after the LP and there is no improvement, we consider referral for an epidural blood patch.…”

Section: Patient Experience and Comfortmentioning

confidence: 99%

Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches

Rhyner

Fountain

Chapman

et al. 2017

AJNR Am J Neuroradiol

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SUMMARY:Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat. Our goal with this review was to describe our techniques for lumbar puncture in the difficult patient, with emphasis on using fluoroscopy in the obese patient and to suggest maneuvers that might make the procedure easier. Combining our experience from performing these procedures on an obese population, we would like to share our tips, especially with trainees early in their career. ABBREVIATIONS:BMI ϭ body mass index; IIH ϭ idiopathic intracranial hypertension; LP ϭ lumbar puncture

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Gender and Post–Dural Puncture Headache

Cited by 88 publications

References 47 publications

Postdural puncture headache: evidence-based review for primary care

Postdural puncture headache: evidence-based review for primary care

Effect of Pre and Post Nursing Intervention on the Occurrence of Tension Headache among Surgical Patients Undergoing Spinal Anesthesia

Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches

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