The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. Post dural puncture headache pdph is a complication occurred after the intervention to investigate cerebrospinal uid. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. Postdural puncture headache is uncommon in young ambulatory. Secondary outcomes were the need for an epidural blood patch, neck stiffness, nausea, and vomiting. This is an analytic, interventional, cross sectional study to evaluate the risk factors of postdural postlumbar puncture headache pdph and the validity of the diagnostic criteria for pdph from the ichd ii. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. Comparison of cutting and pencilpoint spinal needle in spinal anesthesia regarding postdural puncture headache. The literature specifically examining this complication in adolescents is scarce. Postdural puncture headache pdph is a wellknown complication of spinal anesthesia that is usually treated with rest, hydration, and simple analgesics 1. Prolonged leakage of cerebrospinal fluid csf may occur after a dural puncture.
Postdural puncture headache pdph statpearls ncbi bookshelf. Management of postdural puncture headache radius anesthesia. The primary outcome was a visual analog scale score of. Effects of oral caffeine on postdural puncture headache. After reading this article, readers should be able to recognize post dural puncture headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. An updated report 2016 american academy of neurology aan. It is purported to be caused by a cerebrospinal fluid csf leak through an opening in the dura mater, leading to low csf pressure, meningeal traction and exaggerated compensatory cerebral vasodilation. Postdural puncture headache pdph is a headache that may occur 24 to 48 hours after spinal anesthesia or inadvertent epidural subarachnoid puncture. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs.
This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter. Pdf postdural puncture headache pdph is a common complication after. Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space. Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption. Shah advocates the insertion of an epidural catheter for establishing the presence of low csf pressure 4 and csf leak and for injection of the epidural blood patch. Postdural punction headache pdph is a wellknown and common complication of spinal anesthesia. Aug 11, 2010 postdural puncture headache develops in 16%86% after attempted epidural block with large bore needles. Postdural puncture headache remains a prominent clinical concern to the. It remits spontaneously within 2 weeks, or after sealing of the leak with autologous epidural lumbar patch. Postural headache, which is relieved when the patient is supine b. While the classic symptoms of pdpha highlight a positional component that worsens with sitting or standing and improves with lying flat, a small. Ever since the first spinal anesthetic in the late 19th century, the problem of spinal headache or postdural puncture headache pdph has plagued clinicians. Postduralpuncture headache an overview sciencedirect topics. The relationship between spinal needle size, configuration and perforation characteristics of the spinal needle and nonessential leak continues to be controversial.
Postdural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Post dural puncture headache we can prevent it intechopen. The parturient is at particular risk of dural puncture and the subsequent headache because of their sex, young age, and the widespread application of epidural anaesthesia. Epidural blood patch is a recognized treatment for postdural puncture headache pdph. Is there an effect on the development of postdural puncture. Standardizing management of postdural puncture headache in. The mechanism of postdural puncture headache, which is occasionally associated with hearing impairment, is likewise based on low csf pressure. The incidence of postdural puncture headache pdph arising from spinal anesthesia in the. It is thought to be due to a continuous leak of csf through the spinal puncture hole, decompressing the subarachnoid space with secondary stretching of the cranial nerves. Postpartum headache is described as a complaint of headache and neck or shoulder pain in the first 6 weeks after delivery. Caffeine for the prevention and treatment of postdural puncture headache. The diagnosis of postdural puncture headache is most often made on the basis of clinical. However, in the other conditions, injection of blood in the epidural space may cause complications.
August bier noted this adverse effect in 1898 in the first patient to undergo successful spinal anesthesia, a 34yearold laborer undergoing resection of an ulceration of the foot. Performing an epidural, spinal, or a diagnostic myelogram can produce the very distinct pdph. Objectives postdural puncture headache pdph may occur 1272 hours after spinal anesthesia. Cosyntropin versus epidural blood patch ebp for treatment. Guidelines for the management of post dural puncture headache. Postdural puncture headache in the obstetric population. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. Postdural puncture headache pdph is a positional headache ie, worse when the patient sits or stands that usually occurs society guideline links. Postdural puncture headache pdph is a potential expected complication of a lumbar puncture, with symptoms related to traction on painsensitive structures from low cerebrospinal fluid csf pressure intracranial hypotension following a leak of csf at the puncture site. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of postdural puncture headache 24. The most common adverse event associated with lp is postdural puncture headache pdph, which can be incapacitating and cause significant morbidity. Two hundred and five patients, aged 1645 years, undergoing day care surgery were given a spinal anaesthetic using either a 26.
Postdural puncture headache pdph is an important iatrogenic cause of patient morbidity in modern anesthesia, pain management after attempted epidural blocks and after spinal taps. By which mechanism does the epidural blood patch cure headache. The character of postdural puncture headache is throbbing and continuous. Journal of anaesthesiology, clinical pharmacology 2012. Risk of postdural puncture headache in adolescents and adult. Jul 08, 2017 the postdural puncture headache is also known as occipital headache. Postdural puncture headache is the most common serious complica. Pdf postdural puncture headache pdph is a potential severe headache, presumably secondary to the tear in the dura and cause csf leakage, which may. It is usually accompanied by neck stiffness andor subjective hearing symptoms. Postdural puncture headache an overview sciencedirect topics.
Inadvertent dural puncture during epidural anesthesia is a more common cause of pdph than spinal anesthesia because of the use of small. Incidence and management of postdural puncture headache. If you continue browsing the site, you agree to the use of cookies on this website. Sterile technique and selection of an infectionfree puncture site significantly reduce the risk of infection. Apr 25, 2006 pdf postdural puncture headache pdph is a potential severe headache, presumably secondary to the tear in the dura and cause csf leakage, which may. Incidence and prediction of postdural puncture headache. Classification and severity of postdural puncture headache. Pdf on nov 21, 2016, erturk e and others published post dural puncture headache find, read and. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. Postdural puncture headache definition of postdural. Open access full text article postdural puncture headache. Postdural puncture headache pdph was perhaps the first recognized complication of regional anesthesia. Postdural puncture headache pdph is the most common complication of lumbar puncture and may.
Jan 15, 2003 kokki h, salonvaara m, herrgard e, onen p 1999 postdural puncture headache is not an agerelated symptom in children. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid csf leakage through the dural puncture. May 24, 2009 post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Postdural puncture headache pdph is a common complication, following neuraxial techniques. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. Apr 04, 2018 postdural puncture headache pdpha, as defined by the international headache society, is any headache that develops within 5 days of dural puncture and is not better explained by another cause.
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