Post dural puncture headache
Editor-in-Chief: Santosh Patel M.D., FRCA [1]
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Overview
Post dural puncture headache (PDPH) is a complication of spinal anesthesia, diagnostic spinal puncture, or epidural anesthesia.
PDPH typically occurs hours to days after puncture and presents with symptoms such as headache and nausea that typically worsen when the patient assumes an upright posture. It is thought to result from a leakage of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms. The incidence of PDPH is higher with younger patients, complicated or repeated puncture, and use of large diameter needles. Modern, atraumatic needles such as the Sprotte spinal needle leave a smaller perforation and reduce the risk for PDPH.
Some patients require no other treatment than analgesics and bed rest. However, persistent and severe PDPH may require an epidural blood patch. A small amount of the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then "patches" the meningeal leak. The procedure carries the typical risks of any epidural puncture but is highly effective, and further intervention is rarely necessary.