Postdural puncture headache - Pathophysiology and treatment options

Postdural puncture headache (PDPH) is an infrequent, but troubling, syndrom e following therapeutic or diagnostic dural puncture. The classic feature o f PDPH is its postural nature: worse when upright and relieved when supine. Other findings such as visual and auditory changes, nausea, vomiting, neck pain and cranial nerve palsies may occur. The syndrome typically occurs 1 to 3 days following dural puncture. The pathophysiology is related to leaka ge of CSF, with resultant cerebral traction and reflex vasodilation. PDPH i s more common in young patients. Prevention is most important, and can be achieved by using the smallest pos sible noncutting spinal needles. Bed rest is not necessary following dural puncture as a preventative measure. Treatment options include bed rest, oral analgesics and epidural blood patc h (EBP). Prompt use of EBP is usually warranted if no symptomatic relief is apparent within 48 to 72 hours. Prolonged symptoms, especially if the pati ent is unresponsive to EBP, should prompt consideration of other aetiologie s of headache.