Postdural puncture headache pdph is a known consequence of lumbar puncture used for the diagnosis of neurological disorders, as well as during epidural anesthesia. In 1898 bier suffered and was the first to report post dural puncture headache. Headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid csf leakage through the dural puncture. Assessment of the prevalence and associated risk factors. It is usually a severe headache felt at the front or back of your head, which gets better when lying down and worse on sitting or standing. Based on the diagnostic criteria of the international headache society ihs in 2004, the post dural puncture headache can appear up to the fifth day after the procedure and it is self limiting in a week which is. Postdural puncture headache comparative study between pencil point and quincky needle 50 p j m h s vol. May 24, 2009 post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Nguyen, standardizing management of post dural puncture headache in obstetric patients. An epidural blood patch was performed using 15 ml of autologous blood, which relieved her headache. Halker rb, demaerschalk bm, wellik ke, wingerchuk dm, rubin di, crum ba et al.
Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose. It has been over a century since we have known about postdural puncture headache. According to the headache classification committee of the international headache society, 5 headache after lumbar puncture is defined as bilateral headaches that develop within 7 days after an lumbar puncture and disappears within 14 days. 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. This headache, called postdural puncture pdph, or lowpressure headache. Postdural puncture headache develops in 16%86% after attempted epidural block with large bore needles. Candido md associate professor of anesthesiology department of anesthesiology, northwestern university feinberg school of medicine, chicago, il 60611, usa rom a. Comparison of postdural puncture headache in median and paramedian approach under spinal anesthesia in cesarean section afshan nisar, jodat saleem, saqib hussain, khalid bashir abstract background. In 1956, with the introduction of 22g and 24g needles, the incidence was estimated to be 11%. Most leaders dont even know the game they are in simon sinek at live2lead 2016 duration. Jun 29, 2018 spinal headaches or post lumbar puncture headaches occur when the spinal fluid leaks through the puncture site in the membrane surrounding the spinal cord. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. Performing an epidural, spinal, or a diagnostic myelogram can produce the very distinct pdph.
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. Introduction post dural puncture headache classically presents as a postural headache that occurs after puncture of the dura. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. After having an epidural steroid injection or spinal anesthetic procedure, you have a 1 in 100 to 1 in 500 chance of developing a postdural puncture headache. The incidence of inadvertent dural tap at attempted epidural placement in obstetric patients has been reported to be on the order of 0. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. Postpartum headache is a common symptom with multiple causes. 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. The patient reported complete resolution of symptoms and no recurrence of headache.
Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Due to this leakage, the pressure which the spinal fluid exerts on the brain and the spinal cord decreases. Postdural 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. Outcomes included postdural puncture headache, any headache, need for iv fluid or controlled analgesia, need for epidural blood patch, success on first lumbar puncture attempt, nerve root. It should be considered as a safe alternative to an epidural blood patch for the treatment of postlumbarpuncture headaches. Your brain and spinal cord are contained in a bag of fluid. Puncture headache in obstetrics background csf acts as a cushion supporting and protecting the brain. It has been over a century since we have known about post dural puncture headache. Postdural puncture headache core concepts anesthesia. Post lumbar puncture lp headache is one of the most common complications from lps 6 36% incidence and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated. Headache is not an uncommon complaint during the postpartum period. Studies that did not include dural puncture were excluded. Incidences after intentional dural puncture using 2022 swg. Salvador l, carrero e, castillo j, villalonga a, nalda ma.
It is exacerbated by movement and sitting or standing. Because both procedures are common, clinicians interested in headache should be familiar with this entity. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Pathophysiology and management of postdural puncture headache. It can also occur after diagnostic or therapeutic lumbar puncture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. Aug 11, 2010 postdural puncture headache develops in 16%86% after attempted epidural block with large bore needles. Post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Inadvertent dural puncture during epidural anesthesia is a more common cause of pdph than spinal anesthesia because of the use of small. Postdural puncture headache comparative study between 25. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Post dural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1. Postdural puncture headache in the parturient sciencedirect. Postdural puncture headache pdph may follow either deliberate or unintentional accidental penetration of the interdigitating meninges, the dura and arachnoid mater. Reports that were supportive of this technique were based on nonrandomized observational studies. Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its. Post dural puncture headache pdph was first reported just over one hundred years ago. The international classification of headache disorders. 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.
It is a debilitating condition, especially in the parturient, but prompt diagnosis and management can treat it and prevent rare but serious sequelae. Postduralpuncture headache an overview sciencedirect topics. The incidence of post dural puncture headache in children. In 1918 one article published in jama by mac robert rg. It is one of the most common and clinically important complications of regional anaesthesia and analgesia in the obstetric population.
Guidelines for the management of post dural puncture. The following day the patient began to complain of a severe frontal headache with associated neck and back pain, characteristic of a post dural puncture headache pdph. Patients filled out a questionnaire detailing their headache experience on the day of, and the 6 days following, lp. Stevens captain, medical corps, united states naval reserve and adjunct professor. Postpartum headache is described as a complaint of headache and neck or shoulder pain in the first 6 weeks after delivery. Headache attributed to a substance or its withdrawal 88 9. Four years later 1895, corning suggested local spinal anesthesia with cocaine to treat a man with habitual masturbation 2. Listing a study does not mean it has been evaluated by the u. Similarly, history of severe headache following work or auto accident resulting in blunt or penetrating back injury suggest possible dural injury.
Postdural puncture headache pdph was perhaps the first recognized complication of regional anesthesia. Of the children aged 1012 years, two out of seventeen developed a headache 11. Descriptive statistics of gestational age weeks of the patient gestational age weeks group a group b total n 50 50 100 mean 38. Postdural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1. Cosyntropin also reduced the need for epidural blood patch from 30% to 11%. Pdph has the potential to cause considerable morbidity and is a. While the classic symptoms of pdpha highlight a positional component that worsens with sitting or standing and improves with lying flat, a small.
Biers classic description of his severe postural headache would be. Postural headache, which is relieved when the patient is supine b. Relief of post lumbar puncture headache with epidural dextran 40. Caffeine for the prevention and treatment of postdural puncture headache. The risk of a headache after accidental dural puncture i. Caffeine for the prevention and treatment of postdural. However, keep in mind that headaches occur in 12% of all parturients who have an epidural and 15% of parturients who dont have an epidural. Post dural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence. Comparison of postdural puncture headache in median and paramedian approach 300 p j m h s vol. A retrospective study the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. If you continue browsing the site, you agree to the use of cookies on this website. This typically occurs between one day and one week after having the epidural or spinal anaesthetic.
To ascertain the frequency and risk factors for postlumbar puncture headache, we studied all adults who had an ambulatory lumbar puncture lp in a 1year period. High or total spinal block is discussed separately. The headache develops as a consequence of cerebrospinal fluid loss, low intracranial. Those who did not return the questionnaire were telephoned. History of headachethe history of severe headache, which begins 2 to 3 hours after back surgery, spinal anesthesia or epidural procedure suggests possible cause of headache could be dural puncture or laceration.
Postdural puncture headache definition of postdural. Practitioners of anesthesia are universally aware of postdural puncture headache pdph, yet our understanding of this serious complication remains surprisingly incomplete. Procedures that carry a chance of post dural puncture headache include epidurals for laboring women and lumbar punctures for test reasons. Spinal headache or postlumbar puncture headachecauses. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1.
Confronting postdural puncture headache in clinical. Bier experienced and wrote about the first reported postdural puncture headache. Clinical and laboratory research over the last 30 years has shown that use of smallgauge. Prevention of post dural puncture headache with epidural administered dextran 40 letter reg anesth 1992, 17. Puerperal seizures associated with post dural puncture headache. The incidence of postdural puncture headache was observed in 2.
Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence. Differential diagnosis of postpartum headaches medigraphic. Mar 31, 2020 a headache can result if the leak lowers the pressure inside the dura, and this post dural puncture headache can last for weeks and cause discomfort and pain during this time. Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. Ninetyseven questionnaires were returned and the results show that no child aged under ten years developed a headache. Jan 15, 2003 post dural puncture headache pdph is a well recognised complication of spinal and epidural anaesthesia. Epidural blood patch cures postdural puncture headache in 90% of cases d.
This incidence is too high and an alternative technique may be needed. Postdural puncture headache pdph is a well recognised complication of spinal and epidural anaesthesia. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Cerebrospinal fluid lies between 2nd and 3rd layer of membrane, also known as mater. Management of postdural puncture headache radius anesthesia. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent position. This typically occurs 1 to 7 days after undergoing the epidural or spinal anesthetic. The incidence of post dural puncture headache was observed in 2.
Standardizing management of postdural puncture headache in. Lumbar puncture is a procedure that is commonly performed in the emergency department ed for both diagnostic and therapeutic reasons. Postdural puncture headache pdph is the most frequent complication of central neuraxial blockade. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter.
A questionnaire was answered over the next three days to determine the incidence of post dural puncture headache. The headache is usually positional worse when upright, better when lying flat. It is usually accompanied by neck stiffness andor subjective hearing symptoms. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Caffeine sodium benzoate is a simple treatment of postlumbarpuncture headaches. Comparison of postdural puncture headache in median and. This chapter discusses the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to.
Headache after an epidural or spinal anaesthetic the royal. 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. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. About one third of patients develop headaches after lumbar puncture, although the incidence may be higher, as minor symptoms may not be reported. Introduction postdural puncture headache classically presents as a postural headache that occurs after puncture of the dura. The duration of the headache has remained unchanged since that reported in 1956. Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space.
Evidence based management of postdural puncture headache. Jan 12, 2012 the incidence of dural puncture ranges from 0. Post dural 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 pdph is a known complication of spinal anesthesia due to constant spillage of cerebrospinal fluid from the dural. Open access full text article postdural puncture headache. Leakage of csf from the subarachnoid space through a dural breach, can lead to loss of this support. Cosyntropin for prophylaxis against postdural puncture. It explains the causes, symptoms and treatment of the headache. Jul 08, 2017 postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. Guidelines for the management of post dural puncture headache. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. 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. The onset of headache pain and other associated symptoms such as nausea and vomiting that occurs when the patient moves from the horizontal to the upright position and then abates when the patient resumes a horizontal position is the sine qua non of postdural puncture headache figure 121.
Included studies compared atraumatic needles with conventional needles for lumbar puncture. Standardizing management of postdural puncture headache. Postdural 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. It remits spontaneously within 2 weeks, or after sealing of the leak with autologous epidural lumbar patch. Headache attributed to disorder of homoeostasis 107 11. It is usually a severe headache felt at the front or. The resulting traction on the innervated tissues around the brain can be responsible for the headache that follows. Headache attributed to nonvascular intracranial disorder 77 8.