Depending on the severity of the headache, the mother may be unable to adequately care for her. Pdf postdural puncture headache continues to be a significant cause of. Jul 08, 2017 the postdural puncture headache is also known as occipital headache. Biers classic description of his severe postural headache would be familiar to anyone in practice today. Headache after an epidural or spinal anaesthetic the royal. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. There is controversy over whether age and gender are independent risk factors for the development of post dural puncture headache. The overall incidence of postdural puncture headache remains between 0% to 37% after spinal anesthesia5. Keywords epidural blood patch, intrathecal catheter, postdural puncture headache. Postdural puncture headache pdph is an excruciating and debilitating condition typically lasting 3 to 7 days, but some anecdotal reports indicate that it can last up to two or more months. Factors contributing to postlumbar puncture headache jama. Pathophysiology and management of postdural puncture headache.
Evidence based management of postdural puncture headache pdph. Post dural puncture headache pdph may occur following any procedure in which a needle pierces the dura membrane of the spine and subsequently causes spinal fluid to leak out through the puncture hole. It can also occur after diagnostic or therapeutic lumbar puncture. Prevention of postdural puncture headache after accidental. Techniques proven to reduce risk include higher gauge needle use.
By dr saravanavel sagadai topic advisor, nhs evidence surgery, anaesthesia, perioperative and critical care and consultant in anaesthesia, james paget university hospitals nhs foundation trust and dr gokulnath rajendran st3 in anaesthesia, ipswich hospital, ipswich. Guidelines for the management of post dural puncture headache. The headache is usually positional worse when upright, better when lying flat. Puerperal seizures associated with post dural puncture headache. A lumbar puncture is also called a spinal tap or lp. Post dural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. It is a test when a doctor inserts a needle in the lower back to get a sample of cerebrospinal fluid csf that moves.
Posture and fluids for preventing postdural puncture headache. The dose now recommended for the treatment of post. Post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The resulting loss in csf pressure leads to traction on the meninges and a severe headache, which is often positional and accompanied by nausea. About one third of patients develop headaches after lumbar puncture, although the incidence may be higher, as minor symptoms may not be reported.
We present a case of tonicclonic seizure occurring on day four post partum and associated with severe post dural puncture headache. By dr saravanavel sagadai topic advisor, nhs evidence surgery, anaesthesia, perioperative and critical care and consultant in anaesthesia, james paget university hospitals nhs foundation trust and dr gokulnath rajendran st3 in. A postdural puncture headache pdph occurs after intentional in the case of spinal anesthesia or accidental in the case of epidural anesthesia puncture of the dura mater. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. There is controversy over whether age and gender are independent risk factors for the development of postdural puncture headache. Treatment of obstetric postdural puncture headache oaa. A post dural puncture headache pdph occurs after intentional in the case of spinal anesthesia or accidental in the case of epidural anesthesia puncture of the dura mater. Jan 12, 2012 the incidence of dural puncture ranges from 0. It is usually a severe headache felt at the front or back of your head. Guidelines for the management of post dural puncture. This terminology has been officially adopted in the international classification of headache disorders and is used in this section. The incidence of postdural puncture headache was observed in 2. Candido md associate professor of anesthesiology department of anesthesiology, northwestern university feinberg school of medicine, chicago, il 60611, usa rom a.
It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Postpartum headache is a common symptom with multiple causes. Standardizing management of postdural puncture headache in. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898.
Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space. The mechanism of postdural puncture headache, which is occasionally associated with hearing impairment, is likewise based on low csf pressure. The postdural puncture headache is also known as occipital headache. Needle gauge and tip designs for preventing postdural puncture. It explains the causes, symptoms and treatment of the headache. Comparison of postdural puncture headache in median and. Postdural puncture headache pdph is a potential expected complication of a lumbar puncture, with symptoms related to traction on painsensitive structures from low cerebrospinal fluid csf pressure intracranial hypotension following a leak of csf at the puncture site. Good hydration, lying down for a period if the headache occurs and slow mobilization will help. The character of postdural puncture headache is throbbing and continuous. Postduralpuncture headache pdph is a complication of puncture of the dura mater the. Postdural puncture headache pdph is an infrequent, but troubling, syndrome following therapeutic or diagnostic dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smallgauge. Postdural puncture headache core concepts anesthesia.
This syndrome has an estimated incidence from less than 1% to about 5% of. Depending on the severity of the headache, the mother may be unable to adequately care for her newborn or herself for quite some time. In 1918 one article published in jama by mac robert rg. Postdural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. Post dural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. Post dural puncture headache affects up to 30% of patients after lumbar puncture. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of post dural puncture headache 24.
His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. If you continue browsing the site, you agree to the use of cookies on this website. Even if carried out under optimal conditions, postdural puncture headache is still a frustrating and unpleasant complication in spinal anesthesia. To the editor factors associated with postlumbar puncture headache occurrence have been thoroughly highlighted by monserrate et al.
A proforma for recording management and followup of each case and instructions for patients can be found in appendix 2, in the anaesthetic office or can be downloaded from the departmental intranet site. May 24, 2009 post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In the scenario involving epidural analgesia in labor post spinal puncture headache usually happens after inadvertent puncture of the dura, also called dural tap. An external file that holds a picture, illustration, etc. Postdural puncture headache pdph is a common occurrence after spinal anesthesia or inadvertent dural puncture during epidural placement in parturients.
Jan 15, 2003 post dural puncture headache pdph is a well recognised complication of spinal and epidural anaesthesia. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Four years later 1895, corning suggested local spinal anesthesia with cocaine to treat a man with habitual masturbation 2. Open access full text article postdural puncture headache. The resulting loss in csf pressure leads to traction on the meninges and a severe headache, which is often positional and accompanied by. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. In the scenario involving epidural analgesia in labor postspinal puncture headache usually happens after inadvertent puncture of the dura, also called dural tap. Pdf standardizing management of postdural puncture. High or total spinal block is discussed separately. Postdural puncture headache pdph can occur as a result of diagnostic lumbar puncture, spinal anaesthesia, and accidental dural puncture during epidural anaesthesia. Headache after an epidural or spinal injection what you need to. The classic feature of pdph is its postural nature.
Post dural puncture headache pdph is a known complication of spinal anesthesia due to constant spillage of cerebrospinal fluid from the dural. A lumbar puncture is done below where the spinal cord ends, so it is not possible to injure the spinal cord. Evidence based management of post dural puncture headache dr. The patient continued to do well and was discharged at the appropriate time. Headache is not an uncommon complaint during the postpartum period. Postduralpuncture headache an overview sciencedirect topics. The possible underlying aetiologies of this and two other cases we have managed and the difficulty distinguishing such seizures from eclampsia are discussed. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to. Puerperal seizures associated with post dural puncture.
Post duralpuncture headache affects up to 30% of patients after lumbar puncture. Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its. Comparison of postdural puncture headache in median and paramedian approach under spinal anesthesia in cesarean section afshan nisar, jodat saleem, saqib hussain, khalid bashir abstract background. Multiple punctures probably increase the incidence of headaches. Post dural puncture headache did not develop and the patient was discharged home on the third postoperative day. Post dural puncture headache an increased risk of pdph. Postdural puncture headache pdph is an important iatrogenic cause of patient morbidity in modern anesthesia, pain management after attempted epidural blocks and after spinal taps. Atraumatic versus conventional lumbar puncture needles. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Cathie lm sudlow, department of clinical neurosciences, university of edinburgh, western general hospital.
Postduralpuncture headache an overview sciencedirect. However, keep in mind that headaches occur in 12% of all parturients who have an epidural and 15% of parturients who dont have an epidural. Your brain and spinal cord are contained in a bag of fluid. The risk of a headache after accidental dural puncture i. Aug 11, 2010 postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. We performed a metaanalysis of available trials to determine if bevel direction during lumbar puncture would influence the incidence of pdph. Epidural blood patch cures postdural puncture headache in 90% of cases d. The syndrome typically occurs 1 to 3 days following. This headache, called postdural puncture pdph, or lowpressure headache. 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.
It is exacerbated by movement and sitting or standing. Headache is a relatively common complication of neuraxial anesthesia. What links here related changes upload file special pages permanent link page. Other findings such as visual and auditory changes, nausea, vomiting, neck pain and cranial nerve palsies may occur. On occasions a headache may occur post lumbar puncture. Postdural puncture headache definition of postdural. Inadvertent dural puncture during epidural anesthesia is a more common cause of pdph than spinal anesthesia because of the use of small. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. There are reports of pdph symptoms lasting for months or. Postdural puncture headache pdph is one of the most common complications of diagnostic and.
Factors contributing to postlumbar puncture headache. The subarachnoid catheter was left in situ for 24 hours from the initial insertion time in an attempt to decrease the risk of postdural puncture headache. Postdural puncture headache is a possible and expected complication in a small percentage of cases after spinal. Postdural puncture headache pdph is a well recognised complication of spinal and epidural anaesthesia. Postdural puncture headache pdpha has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since bier reported the. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of postdural puncture headache24. Stevens captain, medical corps, united states naval reserve and adjunct professor. In 1898 bier suffered and was the first to report post dural puncture headache. Post dural puncture headache pdph is an excruciating and debilitating condition typically lasting 3 to 7 days, but some anecdotal reports indicate that it can last up to two or more months. Standardizing management of postdural puncture headache. Some cases are so severe that even opioids have little or no effect.
Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilize the patient. Post dural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence. The subarachnoid catheter was left in situ for 24 hours from the initial insertion time in an attempt to decrease the risk of post dural puncture headache. Postdural puncture headache and pregabalin beyazit zencircidepartment of anesthesiology and reanimation, mostas private health hospital, kahramanmaras, turkeybackground. This typically occurs 1 to 7 days after undergoing the epidural or spinal anesthetic. The need to study pdph lies in the fact that it is associated with significant postoperative morbidity. Postdural puncture headache did not develop and the patient was discharged home on the third postoperative day. Suspect pdph in all patients who recently underwent an lp or epidural anesthesia regardless of whether they meet the ihs criteria. Bier experienced and wrote about the first reported postdural puncture headache. However, a north american hospital survey of the treatment of post. Biers classic description of his severe postural headache would be.
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