Post-dural-puncture headache

Post-dural puncture headache (PDPH) is a complication that can occur after a dural puncture, usually as a result of a diagnostic lumbar puncture or epidural anesthesia. The headache is severe and positional, typically worsening when the patient is upright and improving when the patient is lying down.

Causes

The cause of PDPH is believed to be due to a reduction in cerebrospinal fluid (CSF) pressure. The dura mater is a membrane that surrounds the brain and spinal cord, and CSF is the fluid that surrounds these structures. When a hole is made in the dura mater, CSF can leak out, reducing the pressure and leading to a headache.

Symptoms

The main symptom of PDPH is a headache that worsens when the patient is upright and improves when the patient is lying down. Other symptoms can include neck pain, nausea, vomiting, dizziness, tinnitus, and blurred or double vision.

Diagnosis

The diagnosis of PDPH is usually based on the patient's symptoms and the recent history of a dural puncture. In some cases, a magnetic resonance imaging (MRI) scan may be done to rule out other causes of the headache.

Treatment

The treatment of PDPH involves conservative measures such as bed rest, hydration, and pain medications. If these measures are not effective, an epidural blood patch may be performed. This involves injecting the patient's own blood into the epidural space, which can help to seal the hole in the dura mater and restore the CSF pressure.

Prevention

Prevention of PDPH involves using a smaller needle for the dural puncture, as this has been shown to reduce the risk of PDPH. In addition, the patient should be advised to remain lying down for a few hours after the procedure.

See also

• Lumbar puncture
• Epidural anesthesia
• Cerebrospinal fluid

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