Needle gauge and tip designs for preventing post-dural puncture headache (PDPH)

Abstract

There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.

Abstracts and Citations

“…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. When given intravenously to rats, fremanezumab reduced baseline spontaneous activity and activation and sensitization to intracranial dural stimulation of high-threshold trigeminovascular neurons.…”

“…Oral NSAIDs may be used as first-line therapies for migraine or tension-type headache or as rescue for migraine. 2 Studies on parenteral ketorolac (30 mg intravenous or 60 mg intramuscular) show benefit for acute migraine, with data derived from comparative but not placebo-controlled work. There are no well-controlled studies comparing the relative efficacy of different NSAIDs in headache.…”

“…Glucocorticoids remain the primary treatment. 2 Consensusbased guidelines recommend prednisone 40-60 mg/day, followed by a tapering regimen that is individualized based on the clinical course. In certain patient groups, alternative therapies are highly desired: those with diabetes or osteoporosis, those with insufficient response or adverse reactions to glucocorticoids, and those with recurrent relapses or inability to wean steroids.…”

“…In the mAbs migraine trials, to date the incidence of these issues has been low and frankly, neither alarming nor persistent. 2 Since their size prevents crossing the bloodbrain barrier (BBB), therapeutics is dependent on noncentral nervous system sites for action, which is provided by the trigeminal ganglion and its durovascular connections (all outside the BBB) for migraine. Size to date has required injection but half-lives are sufficiently long, although variably 3-6 weeks, that once monthly injection suffices.…”

“…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. 3,4 In the first article, from Tepper et al, 667 patients with chronic migraine were randomly assigned to receive placebo (n 5 286), erenumab 70 mg (n 5 191), or erenumab 140 mg (n 5 190) subcutaneously every 4 weeks for 12 weeks.…”