POSTDURAL PUNCTURE HEADACHE (PDPH) - ONSET, DURATION, SEVERITY, AND ASSOCIATED SYMPTOMS - AN ANALYSIS OF 75 CONSECUTIVE PATIENTS WITH PDPH

Among 873 consecutive patients who had undergone a total of 1021 spina l anaesthesias involving puncture of the lumbar dura, 75 (7.35%) compl ained of Postdural Puncture Headache (PDPH). The severity of each pati ent's PDPH was categorized, on a scale from mild to severe, on the bas is of the onset, duration: severity of the headaches, and the degree t o which they were accompained by auditory and vestibular symptoms. In the patients who developed PDPH, 65% developed symptoms within 24 hour s of the lumbar punctures and 92% developed symptoms within 48 hours. For the patients who recovered spontaneously the mean duration of the PDPHs was 5 days, with a range of 1-12 days. PDPH was characterized by headaches that were influenced by the patient's posture and the sever ity of PDPH was categorized as follows: Mild PDPH resulted in a slight restriction of their physical activity. These patients were not confi ned to bed and had no associated symptoms. Moderate PDPH forced the pa tient to stay in bed for part of the day, and resulted in restricted p hysical activity. Associated symptoms were not necessarily present. Se vere PDPH. Patients were bedridden for the entire day and made no atte mpt to raise their head or to stand. Associated symptoms were always p resent. Fortyfive of the PDPH patients (60%) recovered spontaneously. Of these, 8 patients (11%) were categorized as mild cases of PDPH, 14 (19%) as moderate, and 23 (30%) patients as severe cases of PDPH. Thir ty of the PDPH patients (40%) were treated with an autologous epidural bloodpatch (AEBP). Of these, 27 patients (36%) were classified as sev ere and 3 patients (4%) as moderate PDPH. ASSOCIATED SYMPTOMS were pre sent in all patients who had severe PDPH and in 86 percent of the pati ents who had moderate degrees of PDPH. Of all the patients with PDPH, 60% complained of nausea, 24% of vomiting, 43% of stiffness of the nec k, 13% of ocular symptoms, and 12% of auditive symptoms. The headaches in the PDPH patients were localized to the frontal region, bilaterall y in 25% of the cases, occipitally in 27% of the cases and in both reg ions in the remaining 45% of the patients.