A 33yo G1PO had an epidural for labour. At the time, no problems were noticed and analgesia was satisfactory. It is now 2 days post-partum and she complains of severe headache. You are called to assess her.
Headache Classification Committee of the International Headache Society,
"bilateral headaches that develop within 7 days after a lumbar puncture and disappear within 14 days. The headache worsens within 15 min of resuming the upright position, disappears or improves within 30 min of resuming the recumbent position". .
MRI- may show diffuse dural enhancement with evidence of sagging, descent of the brain and brain stem, obliteration of the basilar cisterns and enlargement of the pituitary gland. (Post grad med journal)
Volume of blood to be injected is controversial. My teaching was up to 20ml of blood. Warn patient they may experience some pain (back and radicular) and if they do so stop injecting the blood. Some say up to 30ml
Patient should lie recumbent for 1-2 hours and not cough/ move dramatically for several hours