Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

Abstract

Objective The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16‐gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. Background Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self‐limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. Methods Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow‐up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. Results Over an 18‐month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow‐up. Of the 39 patients who completed follow‐up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre‐existing headache. Conclusion Post dural puncture headache from an accidental dural puncture can no longer be considered a self‐limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.

Did she have an epidural? The long‐term consequences of postdural puncture headache and the role of unintended dural puncture

“…They noted similar prevalence rates of headache in postpartum women to that found in previous studies. In their study, 30% of 39 patients who suffered UDP reported persistent headache symptoms at 18 months postpartum 5 . Half reported new headaches, and half reported worsening of preexisting headache.…”

“…The most frequent occurs following an unintended dural puncture (UDP) with the large bore Tuohy‐type needle commonly used for the placement of epidural catheters to manage labor pain in the parturient. UDP occurs in 0.7%–1.5% of parturients, and mounting data suggest UDP precipitates new or worsened headache after childbirth in up to a third of women who experience this complication 1–5 . In this paper, we will seek to bridge the literature between two specialties by comparing both the definition of PDPH and its known risk factors from both the neurology and OB anesthesia perspective.…”

Single or Double Bilateral Greater Occipital Nerve Blocks to manage Headache after Spinal Obstetric Anesthesia

“…These findings point to a fact that PDPH is not solely self-limiting condition and necessitate follow-up even for cases with mild manifestations. In line with this assumption, Gauthama et al [34] reported that at 18 months after the procedure, PDPH persisted in 30%, worsened in 15% of patients and another 15% of patients developed new onset headache, so concluded that PDPH can no longer be considered a self-limiting condition.…”

Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study

“…Twenty‐five participants had a contrast‐enhanced MRI of the head; none showed any features consistent with intracranial hypotension. We suggest that short‐term cerebrospinal fluid loss and concomitant intracranial nociceptor activation leads to sensitisation of neurones in the trigeminocervical complex, unless the process is blocked or sufficiently limited early‐on with epidural blood patch [4–6, 16, 18, 26, 27].…”

“…Although post-dural puncture headache can result in significant shortterm distress and morbidity, the general consensus is that it is a self-limiting condition [8][9][10] and the International Headache Society's definition of post-dural puncture headache reflects this consensus [11]. However, there is emerging evidence from retrospective studies that accidental dural puncture may be associated with persistent headache [12][13][14][15][16][17][18]. In addition, there is low-quality evidence that accidental dural puncture and subsequent epidural blood patch may actually increase the risk of new onset low back pain [17,19,20].…”