Post-dural Puncture Head (PDPH) is a common undesired side effect of lumbar puncture (LP). It is connected with the leakage of Cerebrospinal Fluid (CSF) at the puncture site outside of spinal cord – in to the dura mater. The intracranial pressure sensitive structures in the brain react with the lowered intracranial pressure triggering pain and other PDPH-related symptoms. Conservative PDPH-preventing therapy includes prolonged bed rest and increased fluids intake – those guidelines were invented as long ago as LP itself and even though modern day research show no connection between following those guidelines and PDPH occurrence yet it is still performed in medical practice. Research shows that crucial for the likelihood of PDPH occurrence is the type of used needle gauge whether it is traumatic or atraumatic and the needle size (its’ diameter). As for the treatment of prolonged PDPH the most beneficial from the pharmacotherapy is the usage of caffeine (used in treatment of different-based headaches as well) combined with other pain-easing medicines. As for the more invasive method of treatment epidural patch is being used. It works as a patch, made of patients’ blood that covers the hole in the dura mater preventing more CSF from leaking outside. It is the most efficient way of treating PDPH.

Post-dural puncture headache, cerebrospinal fluid, epidural patch, lumbar punctur

Carolynne M. Doherty, Diagnostic Lumbar Puncture, Ulster Med J. 2014 May; 83(2): 93–102.

Costerus JM, Brouwer MC, van de Beek D, Technological advances and changing indications for lumbar puncture in neurological disorders. Lancet Neurol. 2018 Mar;17(3):268-278

Groschel K, Groschel S, How to do: The diagnostic lumbar puncture, Dtsch Med Wochenschr. 2015 May;140(10):738-40

Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ, Management of pediatric patients with pseudotumorcerebripublished on Epub ahead of print on 2012 Jan 19

Kimberly S Johnson, Daniel J Sexton, Lumbar puncture: Technique, indications, contraindications, and complications in adults published on UpToDate 2018 Jul 02

David N. Irani, Cerbrospinal Fluid in Clinical Practice, p: 5-11,2009 ISBN: 978-1-4160-2908-3 Elsevier

Helle H. Damkier, Peter D. Brown, JeppePraetorius, Cerebrospinal Fluid Secretion by the Choroid Plexus, American Physiological Society 2013 Oct; 93(4):1847-1892

Morewood GH, A rational approach to the cause, prevention and treatment of postdural puncture headache. CMAJ. 1993 Oct 15; 149(8):1087-93.

Kyung-HwaKwak, Postdural puncture headache, Korean J Anesthesiol. 2017 Apr; 70(2): 136–143.

D.K. Turnbull, D.B.Shepherd, Post‐dural puncture headache: pathogenesis, prevention and treatment, British Journal of Anaesthesia, 2003 Nov; 91(5):718-729

Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ, Boogaard S, Roqué I Figuls,Needle gauge and tip designs for preventing post-dural puncture headache (PDPH), Cochrane Database Syst Rev. 2017 Apr 7;4:CD010807

Arevalo-Rodriguez I, Ciapponi A, Roqué i Figuls M, Muñoz L, BonfillCosp X, Posture and fluids for preventing post-dural puncture headache, Cochrane Database Syst Rev. 2016 Mar 7;3:CD009199.

van de Beek D, Brouwer MC, Atraumatic lumbar puncture needles: practice needs to change, Lancet 2018 Mar 24;391 (10126):1128-1129

Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ, Boogaard S, Roqué I Figuls M, Needle gauge and tip designs for preventing post-dural puncture headache (PDPH), Cochrane Database Syst Rev. 2017 Apr 7;4:CD010807

SiddharthNath, Jetan H Badhiwala, WaleedAlhazzani, FarshadNassiri, Emilie Belley-Cote, Alex Koziarz, AshkanShoamanesh, Laura Banfield, WieslawOczkowski, Mike Sharma, DemetriosSahlas, Kesava Reddy, ForoughFarrokhyar, Sheila Singh, Sunjay Sharma, Nicole Zytaruk, MagdySelim, Saleh A Almenawer, Atraumatic versus traumatic lumbar puncture needles: a systematic review and meta-analysis protocol. BMJ Open, 2017; (7)3: e014478

BasurtoOna X, MartínezGarcía L, Solà I, BonfillCosp X, Drug therapy for treating post-dural puncture headache, Cochrane Database Syst Rev. 2011 Aug 10;(8):CD007887

Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K, Caffeine in the management of patients with headache, J Headache Pain. 2017 Oct 24;18(1):107

Mahoori A, Hassani E, Noroozinia H, Javaheri N, Hatami S, Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH), Middle East J Anaesthesiol. 2013 Oct;22(3):289-92.

Sjövall S, Kokki M, Turunen E, Laisalmi M, Alahuhta S, Kokki H, Postdural puncture headache and epidural blood patch use in elderly patients,J ClinAnesth. 2015 Nov;27(7):574-8

Katz D, Beilin Y, Review of the Alternatives to Epidural Blood Patch for Treatment of Postdural Puncture Headache in the Parturient, AnesthAnalg. 2017 Apr;124(4):1219-1228

Wong K, Monroe BR, Successful Treatment of Postdural Puncture Headache Using Epidural Fibrin Glue Patch after Persistent Failure of Epidural Blood Patches, Pain Pract. 2017 Sep;17(7):956-960