Post-dural puncture headache: pathophysiology, prevention and treatment

Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-...

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Bibliographic Details
Published in:Best practice & research. Clinical anaesthesiology 2003-09, Vol.17 (3), p.451-469
Main Authors: Candido, Kenneth D, Stevens, Rom A
Format: Article
Language:English
Subjects:
anaesthesia
Anesthesia, Spinal - adverse effects
Anesthesia, Spinal - methods
Blood Patch, Epidural - adverse effects
complications
headache
Headache - drug therapy
Headache - physiopathology
Headache - prevention & control
Humans
Needles
post-dural puncture
spinal
Spinal Puncture
treatment
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Summary:Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural spaces. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPHA than traditional cutting point needle tips (Quincke-point needles). A careful history can rule out other causes of headache. A positional component of headache is the sine qua non of PDPHA. In high-risk patients (e.g. age
ISSN:1521-6896
1532-169X
DOI:10.1016/S1521-6896(03)00033-8