Post-dural puncture headache

Abstract

Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24–48 hours of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare.

Post Dural Puncture Headache (PDPH) and Associated Factors after Spinal Anesthesia among Patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia

“…Post-dural puncture headache typically presents as a postural headache that worsens when a patient is in the upright position and lessens to some extent when a patient is in the recumbent position [1][2][3][4][5][6]. PDPH is believed to originate from persistent leakage of cerebrospinal fluid (CSF) greater than the cerebrospinal fluid production after lumbar puncture [3].…”

“…Women, particularly during pregnancy, are considered at increased risk for PDPH [1,2,4]. High levels of estrogens in women can influence the tone of the cerebral vessels, thus increasing the vascular distension response to CSF hypotension [1][2][3][4].…”

“…The incidence of PDPH is highest in young individuals [1,2,4,5] and lean patients [1][2][3][4]. Women who are obese or morbidly obese may have a decreased incidence of PDPH as a result of the increased in intra-abdominal pressure which acts as an abdominal binder helping to seal the defect in the dura and decreasing the loss of CSF [1].…”

“…The incidence is significantly higher when large bore needles greater than 22 G than when smaller needles (<25 G) were used [1,2,4,5]. Although smaller diameter needle punctures used for spinal block decrease the risk of PDPH, these needles are technically difficult to use and are associated with a lower success rate in spinal anesthesia [1][2][3][4].…”

“…Although smaller diameter needle punctures used for spinal block decrease the risk of PDPH, these needles are technically difficult to use and are associated with a lower success rate in spinal anesthesia [1][2][3][4]. Not only the size of the needle affects the incidence of PDPH, but also the type of needle tips [1,2,4]. The cutting needle bevels are more common to cause PDPH than the less traumatic pencil point needle bevels.…”