Post dural puncture headache is a complication that can occur after a lumbar puncture or spinal anesthesia procedure. It is caused by leakage of cerebrospinal fluid through the puncture site in the dura mater, resulting in a decrease in intracranial pressure. Risk factors include being young, female, having a history of migraines or prior PDPH. Symptoms include frontal or occipital headache that worsens with upright position and improves with lying down. Treatment options range from bed rest, fluids and medications to more definitive treatments like epidural blood patch.

1. POST DURAL PUNCTURE HEADACHE
ADE WIJAYA, MD – SEPTEMBER 2018

2. OUTLINE:
 Introduction
 Risk factors
 Clinical course
 Treatment
 Summary

3. INTRODUCTION
 First reported by August Bier at 1898
 Complications of neuroaxial block or diagnostic lumbar puncture
 Incidence: 0,16 % - 3 %
 CSF leakage  decrease of intracranial pressure causing arteriolar and venous dilatation of cerebral
vessels; distension on pain sensitive structure in cranium
Erturk E, Kutanis D. Post Dural Puncture Headache. Int J Anesth Res. 2016 Nov 21;4(11):348-51.

4. RISK FACTORS
 PDPH incidence is higher especially in young female patients due to increased fiber elasticity of dura
mater
 Increased BMI are related to lower incidence of PDPH. Higher intraabdominal pressure leads to
increased pressure on dependent epidural vein. Thus, this event causes a protection to CSF leakage
through dural puncture
 Former PDPH history
 Migraine and Similar Headache
 Experience of Practitioner
 Needle characteristic
Erturk E, Kutanis D. Post Dural Puncture Headache. Int J Anesth Res. 2016 Nov 21;4(11):348-51.

5. CLINIC COURSE OF PDPH
 Generally occurred in a week after the intervention.
 An obtuse pain in localized generally frontal and occipital region of the head.
 Nausea, vomiting, visual and aural disorders, dizziness and neck stiffness may accompany.
 Symptoms are generally disappeared within two weeks.
 The headache typically worsens within the 15 min of assuming the upright position, improves within 30
min of resuming the recumbent position
Evans RW, Armon C, Frohman EM, Goodin DS (2000) Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the american academy of
neurology. Neurology. 55(7): 909-914
Porhomayon J, Zadeii G, Yarahamadi A, Nader ND (2013) A case of prolonged delayed postdural puncture headache in a patient with multiple sclerosis exacerbated by air travel. Case Rep Anesthesiol. 2013: 253218.

6. TREATMENT
 Bedrest
 Crystalloid and Colloid Fluid Treatment
 Caffeine and Sumatriptan
 Epidural Blood Patch (EBP)
 Epidural Fluid Treatment

7. SUMMARY
 One of the most frequently complication of the neuroaxial intervention.
 PDPH should be recognized, monitored, and treated.

8. THANK YOU