Post-Dural Puncture Headache (PDPH)

Post-dural puncture headache (PDPH) is a type of headache that occurs after a procedure that involves puncturing the dura mater, which is the outermost membrane covering the brain and spinal cord. This condition is also known as post-lumbar puncture headache or spinal headache.

Causes

PDPH is caused by a leak of cerebrospinal fluid (CSF) from the dura mater, which can occur after a lumbar puncture (LP), epidural injection, or other medical procedures that involve inserting a needle into the spinal canal. The leak of CSF can lead to a decrease in the pressure of the CSF, causing the brain to sag and stretch the nerves and blood vessels, resulting in headache.

Symptoms

The symptoms of PDPH typically include:

• A severe, dull, or throbbing headache that is usually worse when standing or sitting upright and improves when lying down
• Nausea and vomiting
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)
• Neck stiffness
• Shoulder or arm pain

Risk Factors

Certain factors can increase the risk of developing PDPH, including:

• Younger age
• Female sex
• Lower body mass index (BMI)
• Use of larger needles or multiple punctures
• Patient anxiety or stress during the procedure

Treatment

Treatment for PDPH typically involves conservative management, including:

• Bed rest and hydration
• Pain relief medications, such as acetaminophen or ibuprofen
• Caffeine, which can help to constrict blood vessels and relieve headache

In some cases, more invasive treatments may be necessary, including:

• Epidural blood patch (EBP), which involves injecting a small amount of blood into the epidural space to seal the leak and restore CSF pressure
• Conservative management with oral or intravenous medications to manage symptoms

Prevention

To reduce the risk of developing PDPH, healthcare providers can take several precautions, including:

• Using smaller needles and atraumatic needles
• Performing the procedure with the patient in a lateral decubitus position (on their side)
• Using a stylet or introducer needle to reduce trauma to the dura mater
• Encouraging patients to stay hydrated and avoid strenuous activities after the procedure

Prognosis

Most cases of PDPH resolve on their own within a few days to a week, although some cases can persist for several weeks or even months. In rare cases, PDPH can lead to more serious complications, such as subdural hematoma or cerebral venous thrombosis.