Post-Dural Puncture Headache: Prevention, Management, and Prognosis
Post-Dural Puncture Headache: Prevention, Management, and Prognosis
Post-dural puncture headache (PDPH) is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. As PDPH can be disabling, clinicians who perform these procedures should be familiar with strategies for preventing this disorder. Since the best preventative measures sometimes fail, clinicians should also be familiar with the therapeutic approaches for PDPH. Herein, we review the procedure-related risk factors for PDPH, the prognosis of PDPH and the studies of PDPH treatment. We divide the therapeutic approach to PDPH into 4 stages: conservative management, aggressive medical management, conventional invasive treatments, and the very rarely employed less conventional invasive treatments and provide management algorithm to facilitate treatment.
Headache interested clinicians are often called upon to diagnose and treat orthostatic headaches, characterized by symptom exacerbation when moving from the supine to upright posture. The most common cause of orthostatic headache is the post-dural puncture headache (PDPH), whether due to deliberate or accidental dural puncture. Attention to procedure-related factors can significantly reduce the incidence of PDPH, so clinicians should be aware of these preventive techniques. Because PDPH is not completely preventable, clinicians should be familiar with the indications and options for treatment. This is a second of a 2-part series on PDPH. In the first article, we considered clinical characteristics and differential diagnosis, prevalence, risk factors as well as the pathophysiology of PDPH. Herein, we consider approaches for preventing and treating PDPH.
Abstract and Introduction
Abstract
Post-dural puncture headache (PDPH) is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. As PDPH can be disabling, clinicians who perform these procedures should be familiar with strategies for preventing this disorder. Since the best preventative measures sometimes fail, clinicians should also be familiar with the therapeutic approaches for PDPH. Herein, we review the procedure-related risk factors for PDPH, the prognosis of PDPH and the studies of PDPH treatment. We divide the therapeutic approach to PDPH into 4 stages: conservative management, aggressive medical management, conventional invasive treatments, and the very rarely employed less conventional invasive treatments and provide management algorithm to facilitate treatment.
Introduction
Headache interested clinicians are often called upon to diagnose and treat orthostatic headaches, characterized by symptom exacerbation when moving from the supine to upright posture. The most common cause of orthostatic headache is the post-dural puncture headache (PDPH), whether due to deliberate or accidental dural puncture. Attention to procedure-related factors can significantly reduce the incidence of PDPH, so clinicians should be aware of these preventive techniques. Because PDPH is not completely preventable, clinicians should be familiar with the indications and options for treatment. This is a second of a 2-part series on PDPH. In the first article, we considered clinical characteristics and differential diagnosis, prevalence, risk factors as well as the pathophysiology of PDPH. Herein, we consider approaches for preventing and treating PDPH.
