Carrie and collins define a pdph as a headache occurring after dural puncture that has a significant effect on the patients post operative well being i. If spinal fluid leaks through the tiny puncture site, you may develop a spinal headache. During the surgery, local anesthetic will be used at the site of the incisions and the pain relief effect should last about 6 hours. Even when they are adhered to, a spinal headache may still occur after the test.
The headache can vary in severity from mild to debilitating. Postdural puncture headache pdph is a common complication after inadvertent dural puncture. Pdph typically presents with headache in frontaloccipital region which is postural in nature, that is worse on standing and better when lying down. Complications of labor epidural anesthesia include a postdural puncture headache pdph.
The patient reported complete resolution of symptoms and no recurrence of headache. Lumbar puncture spinal tap discharge instructions 2 medications you can take your normal prescription medicines as your doctor has instructed you to do. Postdural postlumbar or postspinal puncture headache pdph is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Headache is common in the postpartum period, affecting up to 40% of all parturients. This study was done for evaluating the incidence of pdph following spinal anesthesia in the south. Epidural analgesia in labour, complicated by an accidental dural puncture and a postdural puncture headache pdph occurs not uncommonly. Standardizing management of postdural puncture headache. Diagnosis of post dural puncture headache the post dural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. Methods fiftytwo patients with post spinal headache which had lasted 119 days mean 3. Spinal headache or postlumbar puncture headachecauses. Post dural puncture headache a complication of diagnostic spinal puncture, spinal anaesthesia or epidural anaesthesia is a post dural puncture headache pdph. Biers classic description of his severe postural headache would be familiar to anyone in practice today. It occurs in 1030 % of patients post lumbar puncture.
Post duralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. The spinal canal contains the spinal cord, which carries messages between your brain and your body, and csf. We are at childrens hospital staying at ronald mcdonald house. Pdf since august bier reported the first case in 1898, postdural puncture headache pdph has been a problem for patients following dural puncture find. Post dural puncture headache pdph is one of the most common complications encountered by physicians following spinal anesthesia or lumbar puncture. Presented here is the first published case of a pdph occurring 12 days postpartum. Postdural puncture headache pdph remains a major concern after spinal anesthesia and is known to complicate 0. Almost half of the population who have undergone lumbar puncture spinal tap and spinal anesthesia procedures suffer from a spinal headache or postlumbar puncture. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Headache after an epidural or spinal anaesthetic the royal. Various explanations have been given for the postoperative headache which occasionally follows spinal anesthesia. Discharge instructions for patients after spinal cord.
This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. It is usually a severe headache felt at the front or back of your head, which gets better when lying down and. When headache appears in the postoperative or post partum period after regional anaesthesia it can be due to many reasons, rather as a complication of dural. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their. Spinal headaches, also known as postlumbar puncture headaches, are those headaches which a person suffers after undergoing a lumbar puncture spinal tap and spinal anesthesia. A 2003 metaanalysis described the onset of pdph as occurring from 1 to 7 days after the procedure. This is an analytic, interventional, cross sectional study to evaluate the risk factors of postdural postlumbar puncture headache pdph and the validity of the diagnostic criteria for pdph from the ichd ii. Diagnosis of postdural puncture headache the postdural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with symptoms lasting for several days, at times severe. Neurological sequelae of spinal and epidural anesthesia. Post dural puncture headache, lumbar puncture, epidural anesthesia, spinal anesthesia, headache, hyperbaric oxygen therapy 1.
Headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid csf leakage through the dural puncture. Complications after spinal anesthesia include total spinal anesthesia, postdural puncture headache, backache, neurologic sequelae, and the risk of lumbar epidermoid tumors if nonstyletted needles are used for subarachnoid puncture. Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the tough membrane dura mater that surrounds the spinal cord. Spinal headaches typically last from a few hours to a few days. Leakage of csf from the subarachnoid space through a dural breach, can lead to. If the headache requires treatment, it could involve. Headache is not an uncommon complaint during the postpartum period. Post dural post lumbar or post spinal puncture headache pdph is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Incidence and management of postdural puncture headache. Spinal headache after a spinal tap watch out for these. As csf pressure decreases, such as with a leak, blood vessels in the brain will dilate get bigger. Review article post dural puncture headache semantic scholar. A history of intentional dural puncture, such as lumbar puncture, spinal.
It should be considered as a safe alternative to an epidural blood patch for the treatment of post lumbarpuncture headaches. This headache usually develops within the first week after having the epidural or spinal injection, most commonly within the first few days. It occurs when cerebrospinal fluid spinal fluid that surrounds and cushions the brain leaks out of the meninges tissue that surrounds the brain and spinal cord. Caffeine sodium benzoate is a simple treatment of postlumbarpuncture headaches. Pathophysiology and management of postdural puncture headache. Guidelines for the diagnosis, treatment and prevention of. Incidence of headache is lesser with dural fibre splitting needle such as whitacre needle rather than dura cutting needles such as quincke needle. A new possible pathophysiology article pdf available in anesthesiology and pain medicine 71 february 2017 with 25 reads how we measure reads. Methods fiftytwo patients with postspinal headache which had lasted 119 days mean 3. This headache, called postdural puncture pdph, or lowpressure headache. Total spinal anesthesia has been reported in neonates. In 1956, with the introduction of 22g and 24g needles, the incidence was estimated to be 11%.
Headache is a common sequela of this procedure irrespective of the indication, although the frequency is less with spinal and epidural anaesthesia where fluid is. However, after having an epidural or spinal anaesthetic, you have a 1 in 100 to 1 in 500 chance of developing a post dural puncture headache depending on your age, procedure and other circumstances. Leakage of csf from the subarachnoid space through a dural breach, can lead to loss of this support. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache. Postduralpuncture headache an overview sciencedirect.
Carlo oller, emergency physician, explains a post spinal headache. This complication is believed to be due to a reduction in brain pressure, caused by the leakage of cerebrospinal fluid csf 2. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture. Pdph has the potential to cause considerable morbidity and is a. During postoperactive period, the patient was interviewed for prevalence of postdural puncture headache and associated symptoms on 12 hour of post spinal. Caffeine sodium benzoate is a simple treatment of post lumbarpuncture headaches. Most spinal headaches also known as postlumbar puncture headaches resolve on their own with no treatment. Due to this leakage, the pressure which the spinal fluid exerts on the brain and the spinal cord decreases. About 85 percent of all spinal headaches get better on their own without treatment. Sixhundredandforty patients 332 nonpregnant women and 308 men aged 865 years underwent spinal anesthesia with quincke. Twelve days after an uncomplicated labor epidural a patient was. During spinal anesthesia, medication is injected into your spinal canal to numb the nerves in the lower half of your body. If your headache hasnt improved within 24 hours, your doctor might suggest an epidural blood patch.
Postlumbar puncture headache etiology and management. Pdf lumbar puncture is a frequently performed procedure in medical emergencies and anaesthesia. It explains the causes, symptoms and treatment of the headache. The incidence of inadvertent dural tap at attempted epidural placement in obstetric patients has been reported to be on the order of 0. This fluid contains information about body functions and disease processes. Spinal headaches diagnosis and treatment mayo clinic. Introduction post dural puncture headache classically presents as a postural headache that occurs after puncture of the dura. It remits spontaneously within 2 weeks, or after sealing of the leak with autologous epidural. Spinal headaches occur in about 32 percent of people who receive a spinal. The prevalence of pdph is higher in pregnant women. A postdural puncture headache pdph or spinal headache is usually described as a severe, dull, nonthrobbing pain, usually frontooccipital, which is aggravated in the upright position and diminished in the supine position. Most of them can be classified under the headings of. Postop pain management most patients after spinal cord stimulator surgery complain of pain and discomfort at the incisional sites. Magnitude of post dural puncture headache and associated.
Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. The onset of headache pain and other associated symptoms such as nausea and vomiting that occurs when the patient moves from the horizontal to the upright position and then abates when the patient resumes a horizontal position is the sine qua non of postdural puncture headache figure 121. Associated symptoms include stiff neck, hearing loss, tinnitus, photophobia and nausea. Headache after spinal anesthesia jama surgery jama network. Epidural analgesia in labour, complicated by an accidental dural puncture and a post dural puncture headache pdph occurs not uncommonly. Lumbar puncture is a procedure that is commonly performed in the emergency department ed for both diagnostic and therapeutic reasons. Cosyntropin for prophylaxis against postdural puncture.
Operative management of spinal disorders inpatient physical therapy management of the patient with a spinal disorder undergoing operative management. Caffeine may be used to treat a post procedure headache. Post lumbar puncture lp headache is one of the most common complications from lps 6 36% incidence and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of. It is not uncommon to have incisional pain or discomfort later that evening and. Cosyntropin also reduced the need for epidural blood patch from 30% to 11%. Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilise the patient. Incidence of spinal headache in literature is related to needle size and varies from 0. High or total spinal block is discussed separately. Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache. Lumbar puncture is a frequently performed procedure in medical emergencies and anaesthesia.
May 01, 2018 day 3 of our hospital adventure, dean still has a post spinal lumbar puncture headache but is hoping he can manage the zoo today. The onset is usually within the first three days of the dural puncture 90% of pa tients and 66% starts in the first 48 hours 1 11 12. Standardizing management of postdural puncture headache in. Evaluation of post dural puncture headache using various. During a spinal tap, a sample of cerebrospinal fluid is withdrawn from your spinal canal. It also acts as a cushion to protect the brain and spinal cord from injury. Csf is a clear fluid that flows around the brain and inside the spinal canal. Introduction spinal anesthesia has developed at the end of the 19th century.
It is usually accompanied by neck stiffness andor subjective hearing symptoms. Note level of assistance needed, angle of the head of bed, use of bedrails, and technique used. A rise in carbon dioxide tension in the arterial blood is known to increase cerebral blood flow and csf pressure. It should be considered as a safe alternative to an epidural blood patch for the treatment of postlumbarpuncture headaches. Lumbar puncture, also called an lp or spinal tap, is a procedure where a needle is inserted in your back and into the spinal canal. However, after having an epidural or spinal anaesthetic, you have a 1 in 100 to 1 in 500 chance of developing a post dural puncture headache depending on. Drugs for preventing headache after a lumbar puncture. These headaches feel better when a person is lying down and get worse when sitting up or standing. It has been over a century since we have known about post dural puncture headache. Anesth 22 3, 20 theophylline versus acetaminophen in the treatment of postdural puncture headache pdph alireza mahoori, ebrahim hassani, heydar noroozinia, negin javaheri, sanaz hatami abstract background.
You might need to get fluids through your veins the doctor will call this intravenous fluids. If you are not taking a prescription pain medicine, ask your doctor if you can take an over. Drugs for preventing headache after a lumbar puncture cochrane. Postduralpuncture headache an overview sciencedirect topics. The median approach is the most common technique used, but it is technically difficult. A spinal headache is the name for a type of headache that follows a procedure like a spinal tap lumbar puncture or epidural block such as that performed during labor and delivery. Postdural puncture headache pdph is one of the most common complications encountered by physicians following spinal anesthesia or lumbar puncture. There are two common techniques used in spinal anesthesia, median and paramedian, each of which has advantages and disadvantages. A spinal headache, or postdural headache happens when the puncture made during the spinal tap remains open, and small quantities of cerebrospinal fluid leak through the hole. Post dural puncture headache pdph may occur following any procedure in which a needle pierces the dura membrane of the spine and subsequently causes spinal fluid to leak out through the puncture hole. Without treatment, spinal headaches may go away on their own within 2 days to a couple of weeks.
The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. Evidence based management of postdural puncture headache. Post op pain management most patients after spinal cord stimulator surgery complain of pain and discomfort at the incisional sites. This typically occurs between one day and one week after having the epidural or spinal anaesthetic.
Postdural puncture headache pdph is a common complication after lumbar puncture. This leakage reduces the amount of fluid around the. Postdural puncture headache pdph is the most frequent complication of procedures associated. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Post dural puncture headache pdph was first reported just over one hundred years ago. Guideline for diagnosis and management of post dural puncture headache in obstetrics background csf acts as a cushion supporting and protecting the brain. Post dural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1. They are also known as post dural puncture headaches and epidural headaches. Headache after spinal anesthesia jama surgery jama.
Postdural puncture headache pdph is an important iatrogenic cause of patient morbidity in modern anesthesia, pain management after attempted epidural. Day 3 of our hospital adventure, dean still has a post spinal lumbar puncture headache but is hoping he can manage the zoo today. The complications of epidural anesthesia have been well described and include hypotension, anesthetic toxicity or allergy, high or spinal anesthesia, infection, neurologic injury and post dural puncture headache pdph. However, after having an epidural or spinal injection, you have between a one in 100 and one in 200 chance of developing a postdural puncture headache.