Helpful tips

What is a PDPH?

What is a PDPH?

Postdural puncture headache (PDPH) is a potential expected complication of a lumbar puncture, with symptoms related to traction on pain-sensitive structures from low cerebrospinal fluid (CSF) pressure (intracranial hypotension) following a leak of CSF at the puncture site.[1][2][3]

What causes PDPH?

PDPH is thought to result from a loss of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms.

Is PDPH life threatening?

Although not life-threatening, PDPH carries substantial morbidity by restricting activities of daily life. Current noninvasive treatments, including bed rest, fluids, analgesics, caffeine, and sumatriptan, only temporize the discomfort [29].

What is a dural tap headache?

A post dural puncture headache is an unusual and specific kind of severe headache which can only happen after an epidural or spinal injection. It can be felt at the front or the back of the head. It is worse when sitting or standing and it gets better when lying down flat.

How is PDPH treated?

For the treatment of PDPH, an epidural blood patch is most effective treatment modality, with a high rate of success. Several other treatment modalities for PDPH are available, but high-level evidence supporting their efficacy is still needed.

How do you prevent PDPH?

Immobilization and fluid intake are the two proposed preventive methods that may foster recovery or even prevent PDPH following lumbar puncture. Sicard first recommended bed rest after lumbar puncture in 1902. He asserted that patients should rest for 24 hours to prevent onset of PDPH (Armon 2005).

How common is dural puncture?

The incidence of accidental dural puncture varies on the experience of the provider and is approximately 1.5%. When experts in regional anesthesia were asked regarding the incidence of post dural puncture headache (PDPH), the response was 1% for epidural anesthesia and 1% for spinal anesthesia.

How long are you on bed rest after a lumbar puncture?

The duty physician advises you that the patient will require four hours bed rest after the lumbar puncture. The duty anaesthetist overhears and says that the patient will be able to go home immediately.