Post‐Dural Puncture Headache: Part II – Prevention, Management, and Prognosis

Abstract

Post-dural puncture headache (PDPH) is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. As PDPH can be disabling, clinicians who perform these procedures should be familiar with strategies for preventing this disorder. Since the best preventative measures sometimes fail, clinicians should also be familiar with the therapeutic approaches for PDPH. Herein, we review the procedure-related risk factors for PDPH, the prognosis of PDPH and the studies of PDPH treatment. We divide the therapeutic approach to PDPH into 4 stages: conservative management, aggressive medical management, conventional invasive treatments, and the very rarely employed less conventional invasive treatments and provide management algorithm to facilitate treatment.

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

“…This could be due to as the number of attempt increase the probability of piercing the Dura matter repeatedly will increase, which increases the volume of CSF leak, thereby increasing the probability of development of CSF hypotension & PDPH. This finding in lines with findings of different studies [1,2,5,23] even if some other studies couldn't find significant association between the number of attempts and PDPH development [26,30,31].…”

“…The reason behind this is bigger needles leave bigger opening on the Dura, so more CSF leak than smaller opening caused by smaller needles. Many studies support our finding [1,2,5,21,23,[28][29][30].…”

Common Misconceptions of Lumbar Puncture Complications Among Parents in the Eastern Region of the Kingdom of Saudi Arabia.

“…Administration of oral or intravenous fluids, the use of analgesics and antiemetics, besides maintaining a supine posture are first steps conservative management of post-LP headache, but epidural blood patching is the definitive treatment if conservative management fails (Bezov et al, 2010). Complications such as cortical vein thrombosis and reversible cerebral vasoconstriction syndrome have rarely been reported.…”

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia

“…Sometimes nausea, tinnitus, dizziness and diplopia may occur 11,14 . Mean duration of the PDPH is 7 days 11 , but may take weeks to resolve 17 . The pathophysiology of headache after lumbar puncture is unclear.…”