![]() PDPH is thought to result from a loss of cerebrospinal fluid into the epidural space. It usually resolves within a few days but has been rarely documented to take much longer. The headache usually occurs 24–48 hours after puncture but may occur as many as 12 days after. ![]() PDPH typically occurs hours to days after puncture and presents with symptoms such as headache (which is mostly bi-frontal or occipital) and nausea that typically worsen when the patient assumes an upright posture. PDPH is estimated to occur in between 0.1% and 36% people following dural puncture. The size of the pencil point needle does not appear to make a difference. Using a pencil point needle rather than a cutting spinal needle decreases the risk. It occurs so rarely immediately after puncture that other possible causes should be investigated when it does. Onset occurs within two days in 66% of cases and three days in 90%. Leakage of cerebrospinal fluid causes reduced fluid levels in the brain and spinal cord. PDPH is a common side effect of lumbar puncture and spinal anesthesia. Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are also common. It is exacerbated by movement and sitting or standing and is relieved to some degree by lying down. 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. Post-dural-puncture headache ( PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). ![]() PDPH is a common side effect of spinal anaesthesia (pictured) Post-spinal-puncture headache, post-lumbar-puncture headache All rights reserved.Medical condition Post-dural-puncture headache In addition, obstetricians should be alerted that patients who suffer UDP may be prone to develop chronic headache disorders and consider referral to pain specialists.Ĭopyright © 2021 Wolters Kluwer Health, Inc. In the immediate postpartum setting, clinicians assessing these patients should have a low threshold to obtain brain imaging. Patients who experience UDP or PDPH should be counseled to return for evaluation for new or worsening headache. A growing body of literature also links PDPH or unintentional dural puncture with an epidural needle (UDP) with development of chronic headaches. The authors also identified associations between PDPH and bacterial meningitis, depression, and back pain. A recent large database study links PDPH to subdural hematoma and cerebral venous sinus thrombosis. In this review, authors will discuss the differential diagnosis and management of postpartum headache, review PDPH, and explore evidence suggesting that PDPH may have greater implications than previously considered.Įmerging evidence suggests that PDPH, previously believed to be benign and self-limited, is associated with significant acute and chronic sequelae. ![]() Post dural puncture headache (PDPH) after neuraxial anesthesia is a culprit that may be less familiar to obstetricians. Postpartum headache is a common occurrence with various obstetric, neurologic, and anesthetic etiologies. ![]()
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