Postpartum headache – diagnosis and treatment

Janvier, Anne-Sophie; Russell, Robin

doi:10.1016/j.bjae.2021.12.004

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…40 Appropriate clinical and neurological examination, imaging studies and regular follow-up should be performed based on the clinical presentation to ensure correct diagnosis and treatment of headache.…”

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confidence: 99%

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Uppal,

Russell,

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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IntroductionPostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.MethodsBased on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.ResultsBased on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.ConclusionsThese clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients’ interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.

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confidence: 99%

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Uppal,

Russell,

Sondekoppam

et al. 2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

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Post dural puncture headache and its potential to obscure sinister pathologies: A case report

Hewawasam,

Sumithraarachchi,

Ratnayake

et al. 2024

Preprint

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Background Cerebral venous sinus thrombosis (CVT) is a potentially fatal condition that can occur in postpartum period with the hypercoagulable state developed in pregnancy. Accidental dural puncture is found to be a risk factor for CVT. However, common occurrence of post-dural puncture headache (PDPH) following accidental dural puncture can mask the clinical presentation of other serious conditions such as CVT.Case Presentation We present a case of 29-year-old postpartum female who had accidental dural puncture during labour epidural insertion and managed for PDPH subsequently found to have CVT following further investigation due to persistent symptoms.Conclusions This case report would allow increasing awareness among perioperative clinicians to keenly exclude serious pathology in the presence of possible PDPH as this is a diagnosis of exclusion although there is a history of dural puncture.

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Oral Ergotamine versus Theophylline as Treatment of Post-dural Puncture Headache (PDPH) in Cesarean Section: A Randomized Clinical Trial

Manouchehrian,

Jiriaii,

Sepehri

2023

TOATJ

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Introduction: Post Dural Puncture Headache is (PDPH) a relatively common complication of spinal anesthesia. This study aimed to compare the effect of oral administration of ergotamine and theophylline on PDPH in patients undergoing a cesarean section. Materials and Methods: This clinical trial was performed on 60 parturients undergoing cesarean section with PDPH. A tablet of theophylline (100 mg) or methyl ergotamine C (1 mg plus 100 mg caffeine) every 8 hours for 24 hours was administered randomly to patients referred to the hospital with PDPH. Using a checklist, demographic information, history of previous PDPH, number of punctures and intensity, location, and onset time of headache were collected. Intensity and duration of PDPH in the first 24 hours after surgery were the primary outcomes and nausea, vomiting, and vertigo were considered secondary outcomes. The intensity of the headache was assessed using Visual Analog Scale (VAS) before and within the first 24 hours after drug administration. Results and Discussion: In both groups, the VAS of headache significantly decreased at 2, 8, and 24 hours after administration of theophylline and ergotamine compared to pre-intervention time (theophylline from 8.6 ± 1.1 to 0.2 ± 0.1 and ergotamine from 8.6 ± 1.5 to 0.4 ± 0.2). However, the intensity of headaches was not different between the two groups at 2, 8, and 24 hours after the intervention. Duration of headache was similar in both groups (15.7 ± 5.9 in the theophylline group versus 17.5 ± 14.2 ergotamine group). In terms of secondary outcomes of nausea, vomiting, and vertigo, both groups were comparable. Conclusion: Oral administration of theophylline and ergotamine are similarly effective in reducing PDPH in cesarean sections. Clinical Trial Registration Number: IRCT20120915010841N14.

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Postpartum headache – diagnosis and treatment

Cited by 3 publications

References 24 publications

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Post dural puncture headache and its potential to obscure sinister pathologies: A case report

Oral Ergotamine versus Theophylline as Treatment of Post-dural Puncture Headache (PDPH) in Cesarean Section: A Randomized Clinical Trial

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