Post-dural-puncture headache

Post-dural-puncture headache
Other namesPost-spinal-puncture headache,[1] post-lumbar-puncture headache,[2] spinal headache, epidural headache, low-pressure headache
PDPH is a common side effect of spinal anaesthesia (pictured).
SpecialtyAnaesthesiology

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord).[3] 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. It is exacerbated by movement and sitting or standing and is relieved to some degree by lying down. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are also common.[3]

PDPH is a common side effect of lumbar puncture and spinal anesthesia. Leakage of cerebrospinal fluid causes reduced fluid pressure in the brain and spinal cord. Onset occurs within two days in 66% of cases and three days in 90%. It occurs so rarely immediately after puncture that other possible causes should be investigated when it does.[3]

Using a pencil-point needle rather than a cutting spinal needle decreases the risk of developing PDPH.[4][1] Smaller needle gauges decrease the odds of PDPH, but make it more challenging to perform the procedure successfully.[3][1] The needle with the lowest PDPH rate and highest succession rate is the 26G pencil-point needle.[5] Its estimated PDPH rate is between 2% and 10%.[1]

  1. ^ a b c d Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA (2013). "Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors". Caspian Journal of Internal Medicine. 4 (1): 595–602. PMC 3762227. PMID 24009943.
  2. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
  3. ^ a b c d Turnbull DK, Shepherd DB (November 2003). "Post-dural puncture headache: pathogenesis, prevention and treatment". British Journal of Anaesthesia. 91 (5): 718–29. doi:10.1093/bja/aeg231. PMID 14570796.
  4. ^ Arevalo-Rodriguez, Ingrid; Muñoz, Luis; Godoy-Casasbuenas, Natalia; Ciapponi, Agustín; Arevalo, Jimmy J; Boogaard, Sabine; Roqué i Figuls, Marta (2017-04-07). "Needle gauge and tip designs for preventing post-dural puncture headache (PDPH)". The Cochrane Database of Systematic Reviews. 2017 (4): CD010807. doi:10.1002/14651858.CD010807.pub2. ISSN 1469-493X. PMC 6478120. PMID 28388808.
  5. ^ Maranhao, B.; Liu, M.; Palanisamy, A.; Monks, D. T.; Singh, P. M. (August 2021). "The association between post-dural puncture headache and needle type during spinal anaesthesia: a systematic review and network meta-analysis". Anaesthesia. 76 (8): 1098–1110. doi:10.1111/anae.15320. ISSN 1365-2044. PMID 33332606.