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Postdural Puncture Headache

DOI: 10.1155/2010/102967

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Postdural puncture headache (PDPH) has been a problem for patients, following dural puncture, since August Bier reported the first case in 1898. His paper discussed the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients , for example, age < 50 years, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24–48?h of dural puncture. The optimum volume of blood has been shown to be 12–20?mL for adult patients. Complications of AEBP are rare. 1. Introduction PDPH is an important iatrogenic cause of patient morbidity in modern day anesthesia and pain management practice after attempted epidural block. The incidence of dural puncture, in the literature, ranges from 0.16% to 1.3% in experienced hands [1]. Postdural puncture headache develops in 16%–86% after attempted epidural block with large bore needles [2]. Any breach in the dura may result in PDPH. A breach can be either iatrogenic or spontaneous. Performing an epidural, spinal, or a diagnostic myelogram can produce the very distinct PDPH. It usually occurs within 48 hours postprocedure. Spontaneous CSF leaks leading to headache are usually seen in the cervical-thoracic region and are also associated with comorbidities like Marfan’s syndrome, neurofibromatosis, connective tissue disorders, and Ehler’s Danlos [3]. According to the International Headache Society, the criteria for PDPH [4] include a headache that develops less than seven days after a spinal puncture, occurs or worsens less than fifteen minutes after assuming the upright position, and improves less than thirty minutes in the recumbent position with at least one of the following (neck stiffness, tinnitus, hypacusia, photophobia, and nausea). The headache should disappear within fourteen days after a spinal puncture; if it persists, it is called a CSF fistula headache. 2. History The history of spinal anesthesia can be traced back to the late 1800s when Wynter and Quincke aspirated cerebrospinal from patients with tuberculous meningitis in an attempt to lower intracranial pressure [5]. Shortly thereafter, John Corning attempted to use spinal


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