Headache in the parturient: Pathophysiology and management of post-dural puncture headache

Nath, Gita; Maddirala, Subrahmanyam

doi:10.4103/2249-4472.93988

Cited by 7 publications

(5 citation statements)

References 114 publications

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“…To these changes we would have to add the elevation that can be produced due to the maternal efforts. These data explain why the CPPD is more frequent in the pregnant woman and also why it is better to perform the puncture in the left lateral decubitus position, avoiding the sitting position [42][43][44].…”

Section: International Journal Of Anesthesiology and Pain Medicine Issn 2471-982xmentioning

confidence: 99%

Factors that influence the appearance of dural post-puncture headache in patients undergoing elective cesarean section.

Carrazana¹,

Bazán²,

Sánchez³

et al. 2019

IPAPM

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An epidemiological, observational, analytical and retrospective study of cases and controls was conducted with women undergoing elective cesarean section under spinal anesthesia at the Carlos Manuel de Céspedes Hospital in Bayamo, Granma province, from February 2013 to December 2015; with the objective of identifying the risk factors hypothetically related to the appearance of postpuncture dural headache in obstetric patients undergoing elective cesarean section.All the patients who gave their consent to participate, their data collection form was prepared for the study that collected the variables of the study. In addition, with each hypothetically influencing factor, the estimate of the benefit frame (OR) and its 95% confidence intervals (95% CI) and the hypothesis test of Chi to Square were performed. The age less than 25 years, the history of previous headache, the diameter of the needle of 20 and 22G, the greater number of puncture attempts and the position of the seated patient are the risk factors related to the appearance of post-puncture headache dural, but not the body mass index higher than 30 in obstetric patients undergoing elective cesarean section.

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Section: International Journal Of Anesthesiology and Pain Medicine Issn 2471-982xmentioning

confidence: 99%

Factors that influence the appearance of dural post-puncture headache in patients undergoing elective cesarean section.

Carrazana¹,

Bazán²,

Sánchez³

et al. 2019

IPAPM

View full text Add to dashboard Cite

show abstract

“…Therefore, in the first two days after EBP, the improvement of clinical symptoms is mainly derived from increased subarachnoid pressure. After formation of the mature clot and sealing of the thecal sac, a reduction in the spinal CSF leak number can be observed [14,15]. As such, a higher spinal CSF leakage number may be seen within 0-2 days after EBP, and the EBP effect could last for several days.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Target Epidural Blood Patch Treatment Efficacy in Spontaneous Intracranial Hypotension Using Follow-Up MRI

et al. 2022

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Objectives: Epidural blood patching (EBP) is the mainstay therapy for spontaneous intracranial hypotension (SIH). MRI is used for evaluating spinal CSF leakage. Post-EBP MRI has been. shown to be effective in predicting the efficacy of EBP. However, there are few reports on how post-EBP MRI findings may change with time. The aim of this study was to evaluate the relationship between post-EBP MRI findings at different time points and the corresponding effectiveness of EBP. Methods: We retrospectively reviewed 63 SIH patients who had received target EBP. All patients received an MRI follow-up within 10 days (post-EBP MRI) and at 3 months after EBP (3-month MRI). A sub-group analysis was performed at different post-EBP MRI time points (0–2, 3–6, and 7–10 days). The relationships between the post-EBP MRI findings and the EBP effectiveness were evaluated. Results: Thirty-five (55.56%) patients were assigned to the EBP-effective group, and 28 (44.44%) were assigned to the EBP non-effective group according to the 3-month MRI. Compared to the EBP non-effective group, the EBP-effective group had significantly lower numbers of spinal CSF leakage in the post-EBP MRI (4.49 vs. 11.71; p = 0.000) and greater numbers of leakage improvement (7.66 vs. 2.96; p = 0.003). For patients who received post-EBP MRI during periods of 0–10, 0–2, 3–6, and 7–10 days, the cutoff values of numbers of spinal CSF leakage for predicting EBP failure were 4, 6, 4, and 5, respectively, with an AUC above 0.77. Conclusion: By using post-EBP MRI, which only takes approximately 20 min, predicting EBP efficacy became possible in SIH patients. This study provides cutoff values of numbers of spinal CSF leakage at different follow-up times to serve as clues of if further EBP is needed, which provides the novelty of the current study.

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“…Pneumocephalus is defined as the presence of air in the epidural, subdural, or subarachnoid space, within the brain parenchyma or ventricular cavities [ 1 ], which is most commonly seen following head and facial trauma and neurosurgery or otorhinolaryngological procedures. With the global popularity of epidural labor analgesia techniques, post-dural puncture headache (PDPH) has become a common cause of headache in parturients with an incidence ranging from 0.5% to 1.7% [ 2 ], while pneumocephalus is a rare complication of epidural anesthesia. However, the true incidence of pneumocephalus in obstetrics is very difficult to establish, mainly due to the fact that available literature largely reflects a few cases reported annually [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Post-dural puncture headache combined with pneumocephalus secondary to vaginal delivery following epidural anesthesia: a case report

Wu,

Cao,

Zhang

et al. 2023

BMC Pregnancy Childbirth

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Background Pneumocephalus is rare in vaginal deliveries. Pneumocephalus may be asymptomatic or present with signs of increased intracranial pressure. However, parturients who received epidural anesthesia with air in their brains may experience low intracranial pressure headaches after giving birth, causing the diagnosis of pneumocephalus to be delayed. We report a case of a parturient who developed post-dural puncture headache combined with pneumocephalus secondary to vaginal delivery following epidural anesthesia. Case presentation A 24-year-old G1P0 Chinese woman at 38 weeks gestation was in labor and received epidural anesthesia using the loss of resistance to air technique and had a negative prior medical history. She presented with postural headache, neck stiffness and auditory changes 2 h after vaginal delivery. The head non-contrast computed tomography revealed distributed gas density shadows in the brain, indicating pneumocephalus. Her headache was relieved by bed rest, rehydration, analgesia, and oxygen therapy and completely disappeared after 2 weeks of postpartum bed rest. Conclusions This is the first report that positional headaches after epidural anesthesia may not indicate low intracranial pressure alone; it may combine with pneumocephalus, particularly when using the loss of resistance to air technique. At this moment, head computed tomography is essential to discover other conditions like pneumocephalus.

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Headache in the parturient: Pathophysiology and management of post-dural puncture headache

Cited by 7 publications

References 114 publications

Factors that influence the appearance of dural post-puncture headache in patients undergoing elective cesarean section.

Factors that influence the appearance of dural post-puncture headache in patients undergoing elective cesarean section.

Prediction of Target Epidural Blood Patch Treatment Efficacy in Spontaneous Intracranial Hypotension Using Follow-Up MRI

Post-dural puncture headache combined with pneumocephalus secondary to vaginal delivery following epidural anesthesia: a case report

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