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Post-Dural-Puncture Headache

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes that surround the brain and spinal cord). It is a common side-effect of spinal anesthesia and lumbar puncture and may accidentally occur in epidural anesthesia. The leakage of cerebrospinal fluid through the dura mater puncture causes reduced fluid levels in the brain and spinal cord, and can lead to the development of PDPH hours or days later. Most cases occur within two days and within three days in ninety percent of PDPH cases.

Symptoms

The headache is severe and described as “searing and spreading like lava,” it involves the back and front of the head, and spreads to the neck and shoulders, occasionally neck stiffness occurs. It is made worse by movement, sitting or standing, and relieved to some degree by lying down. Vomiting nausea, pain in arms and legs, hearing loss, vertigo, tinnitus dizziness and paraesthesia of the scalp are also common complaints.

Treatments

In many cases no other treatment other than analgesics and bed rest are needed. However, persistent and severe PDPH may require an epidural blood patch. In this procedure, a small amount of the patient’s blood is injected into the epidural space to increase pressure lost due to the leak and relieve symptoms. The body itself will heal the defect in time.

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