We report a patient with a history of frequent migraine attacks who developed postdural puncture headache that persisted for 3 months. Open access full text article postdural puncture headache. Sumatriptan in patients with postdural puncture headache. As part of an extensive biochemical migraine research program, we assessed the occurrence, duration, and characteristics of. 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. Jan 15, 2003 kokki h, salonvaara m, herrgard e, onen p 1999 postdural puncture headache is not an agerelated symptom in children. In our institute, we routinely practice epidural analgesia ea for supramajor surgeries. Four years later 1895, corning suggested local spinal anesthesia with cocaine to treat a man with habitual masturbation 2. Postdural puncture headache pdph may occur following any procedure in which a needle pierces the dura membrane of the spine and subsequently causes spinal fluid to leak out through the puncture hole. Intravenous administration of caffeine sodium benzoate for. Because of quality of patients life is deteriorated by it, it. 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.
Impact of obesity on postdural puncture headache sciencedirect. Postdural puncture headache pdph is a wellknown complication of spinal anesthesia that is usually treated with rest, hydration, and simple analgesics 1. We describe a case of pdph after unsuccessful epidural placement, followed by successful combined spinalepidural placement. Postdural puncture headache pdph following accidental dural puncture. His migraine attacks ceased during the period of his postdural puncture headache, but resumed 3 days after disappearance of that headache. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. If you continue browsing the site, you agree to the use of cookies on this website.
In the first part of the investigation study part i, 10 ml of blood was injected for ebp in 28 patients. Pdf postdural puncture headache pdph is a common complication after inadvertent dural puncture. Postdural puncture headache in the obstetric population. There is controversy over whether age and gender are independent risk factors for the development of postdural puncture headache. Postdural puncture headache pdph is a benign condition and the most frequent complication of spinal anesthesia. Guidelines for the management of post dural puncture headache. To prospectively assess 1 the incidence and duration of postdural puncture headache pdph in migraineurs and healthy subjects. Postdural puncture headache after continuous spinal anesthesia. Pdf post dural puncture headache international journal of. The character of postdural puncture headache is throbbing and continuous. Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space.
Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and. 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. Postdural puncture headache pdph is a complication of spinal anesthesia and unintentional dural puncture during attempted epidural anesthesia. Post dural puncture headache pdph is a complication occurred after the intervention to investigate cerebrospinal uid. Postdural puncture headache with extensive spread of lumbar. Postdural puncture headache pdph was perhaps the first recognized complication of regional anesthesia. This is an analytic, interventional, cross sectional study to evaluate the risk factors of postdural postlumbar puncture headache pdph and the. Postdural puncture headache pdph is one of the complications following spinal anaesthesia sa and accidental dural puncture adp.
Postdural puncture headache and epidural blood patch. Postdural puncture headache management headache is not an uncommon complaint during the postpartum period. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. Lhermitte sign associated with postdural puncture headache in a parturient. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of postdural puncture headache 24. In 1898 bier suffered and was the first to report post dural puncture headache. Postdural puncture headache pdph is a headache that may occur 24 to 48 hours after spinal anesthesia or inadvertent epidural subarachnoid puncture. Lh wee, f lam, aj cranstonthe incidence of post dural puncture headache in children.
Standardizing management of postdural puncture headache in. This prospective investigation was conducted to evaluate the efficacy of different volumes of epidural blood patch ebp for treatment of postdural puncture headache pdph in 81 consecutive patients. The incidence of postdural puncture headache was observed in 2. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. We experienced postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. Congratulations to soo lo and colleagues june 12, p 20381 for uncovering an anaesthetic trickofthetrade. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. Dural puncture is a commonly performed invasive pro cedure for various indications like diagnostic lumbar puncture, spinal anaesthesia, myelography and. Though it is clear that reducing the size of the dural perforation reduces the. Cohen s, sakr a, katyal s, chopra d 2009 sphenopalatine ganglion block for postdural puncture headache. Jul 08, 2017 the postdural puncture headache is also known as occipital headache. 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.
Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Epidural analgesia in labour, complicated by an accidental dural puncture and a postdural puncture headache pdph occurs not uncommonly. Methods sixty asa i and ii patients undergoing lower abdominal or lower extremity surgery were included in this study. Post dural puncture headache pdph is a complication occurred after the intervention to investigate cerebrospinal fluid by neurologist or to spinal or epidural anesthesia by anesthetist. A 39yrold woman experienced inadvertent dural puncture during labour epidural placement at the l34 level. May 24, 2009 post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. 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. Effectiveness of lateral decubitus position for preventing postdural. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. We hope that this case report would be helpful in situation which a postpartum young woman complains severe headache in spite of management for headache including autologous epidural blood patch. Ten patients with postdural puncture headache presenting for an.
Postdural puncture headache elsevier article locator. Efficacy of epidural blood patch for postdural puncture headache. Pdf post dural puncture headache international journal. Shah that our case report illustrates the difficulty in the diagnosis of postpartum headache, although his suggestion that a cerebrospinal fluid csf leak be demonstrated before performing epidural blood patch for postdural puncture headache pdph does not conform with current practice. For full access to this pdf, sign in to an existing account, or. The headache is usually positional worse when upright, better when lying flat. Incidence and management of postdural puncture headache. Aug 11, 2010 postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Kent s, mehaffey g 2016 transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. The mechanism of postdural puncture headache, which is occasionally associated with hearing impairment, is likewise based on low csf pressure. They describe the use of atraumatic spinal needles to prevent headache after lumbar puncture in patients undergoing intrathecal chemotherapy.
Postdural puncture headache pdph is a relatively common complication of lumbar punctures for spinal anesthesia or neurologic diagnosis. In this setting, a diagnosis of postdural puncture headache is one of exclusion. 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. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Cosyntropin versus epidural blood patch ebp for treatment. Postdural puncture headache pdph is a common complication after inadvertent dural puncture. Use of intravenous cosyntropin in the treatment of postdural. Sphenopalatine ganglion block for postdural puncture headache. Postdural puncture headache an overview sciencedirect topics. Sumatriptan has been used successfully in patients with postdural puncture headache, however, its use has not been investigated in a controlled fashion. Postdural puncture subdural hematoma or postdural puncture. Intravenous cosyntropin versus epidural blood patch for. Postdural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord.
Postdural puncture headache in migraineurs and nonheadache. Sep 30, 2015 subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Pdf on nov 21, 2016, erturk e and others published post dural puncture headache find. Mar 20, 2015 cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter. Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache. Postdural puncture headache advances in anesthesia. 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. Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. Practitioners of anesthesia are universally aware of postdural puncture headache pdph, yet our understanding of this serious complication remains surprisingly incomplete. Background and objectives in this study, we evaluated the efficacy and safety of prophylactic administration of intravenous caffeine sodium benzoate for postdural puncture headaches pdph on patients administered spinal anesthesia. Postduralpuncture headache an overview sciencedirect topics.
Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. However, their report warrants some comment, and their technique some refinement. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and. Postdural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Postdural puncture headache can be quite severe, requiring invasive therapy ie, epidural blood patch. Postdural puncture headache definition of postdural. Pdf download for postdural postlumbar puncture headache. Postdural puncture headache pdph is a common complication, following neuraxial techniques. Though both vomiting and a high incidence of postdural puncture headache were noted, it was the high mortality rate in. Guidelines for the management of post dural puncture.
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