Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

Abstract

Introduction. Post-dural puncture headache is classified as a secondary headache attributable to non-vascular intracranial disorders and belongs to the group of headaches caused by low cerebrospinal fluid pressure. Etiopathogenesis. The pathogenesis is not completely clear, but it is thought to be caused by the cerebrospinal fluid leak through the duct opening. Cerebrospinal fluid efflux leads to a decrease in intracranial pressure and stretching of the pain sensitive intracranial structures. A drop in intracranial pressure can cause compensatory cerebrovascular vasodilation, contributing to the onset of a headache. Diagnosis and Therapy. Post-dural puncture headache clinically presents as an orthostatic headache. In most cases, the diagnosis is made based on a typical clinical picture and it can be confirmed by magnetic resonance imaging and measurement of cerebrospinal fluid pressure. The condition is usually benign, most often with spontaneous recovery. The therapy involves conservative treatment, medications, as well as some invasive methods: epidural blood patches, blockage of the greater occipital nerve, and in most severe cases, epidural injection of fibrin sealant or surgical dural repair. Conclusion. Post-dural puncture headache is a common complaint in the clinical practice of neurologists and anesthesiologists. The prognosis is usually favourable, while the therapy may include conservative or invasive treatment procedures.

Lived Experiences of Mothers With/Without Post Dural Puncture Headache and its Effects on Early Initiation of Breastfeeding at Federal Medical Centre, Abeokuta, Nigeria

“…Post Dural Puncture Headache is classified as a secondary headache attributable to nonvascular intracranial disorders and belongs to the group of headache caused by low cerebrospinal fluid pressure (8).…”

“…Although headache is found to be more common after general anesthesia than after spinal anesthesia, the high incidence of non-specific postoperative headache after spinal anesthesia requires special attention (8).…”

Comparison of post-dural puncture headache incidence among patients undergoing spinal anaesthesia for elective caesarean section by using quincke 25-G and 29-G spinal needles

“…2 The mechanism underlying headache is loss of cerebrospinal fluid through dural hole that leads to traction on cerebral contents and dilation of intra cranial vessels. 3,4 There are variety of factors contributing to PDPH including age of the patient, gender, previous history, guage (G) of spinal needle, type of spinal needle, pregnancy, orientation of needle to dural fibers and expertise of administrator. [5][6][7] In our settings, mostly spinal anaesthesia is administered employing Quincke needles.…”